Provider Demographics
NPI:1982628038
Name:ANTHONY, PATRICIA B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:B
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1439
Mailing Address - Country:US
Mailing Address - Phone:315-472-7626
Mailing Address - Fax:
Practice Address - Street 1:216 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1439
Practice Address - Country:US
Practice Address - Phone:315-472-7626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR019009-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52573BMedicare ID - Type Unspecified