Provider Demographics
NPI:1821168089
Name:PATRICK, ANNIE MULLEN (LMHC, MA, CASAC)
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:MULLEN
Last Name:PATRICK
Suffix:
Gender:F
Credentials:LMHC, MA, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MAVERICK RD
Mailing Address - Street 2:P.O. BOX 1108
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:239 GOLDEN HILL LN
Practice Address - Street 2:UCMHD
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6441
Practice Address - Country:US
Practice Address - Phone:845-340-4000
Practice Address - Fax:845-340-4094
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3423101YA0400X
NY001128-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3423OtherCASAC
NY001128-1OtherLMHC