Provider Demographics
NPI:1861674970
Name:PATRICIA PARKER ACSW LCSW PA
Entity Type:Organization
Organization Name:PATRICIA PARKER ACSW LCSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW LCSW
Authorized Official - Phone:813-983-8100
Mailing Address - Street 1:12108 N 56TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1686
Mailing Address - Country:US
Mailing Address - Phone:813-983-8100
Mailing Address - Fax:352-518-0063
Practice Address - Street 1:12108 N 56TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1686
Practice Address - Country:US
Practice Address - Phone:813-983-8100
Practice Address - Fax:352-518-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW0002097101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty