Provider Demographics
NPI:1861487175
Name:BRESCIA-CANTINE, PATRICIA A (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:BRESCIA-CANTINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:BRESCLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:95 OHAYO MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1441
Mailing Address - Country:US
Mailing Address - Phone:845-399-4261
Mailing Address - Fax:
Practice Address - Street 1:15 PINE GROVE ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1507
Practice Address - Country:US
Practice Address - Phone:845-679-5511
Practice Address - Fax:845-679-0324
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI4467104100000X
NY0757741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM75315Medicaid