Provider Demographics
NPI:1184811812
Name:CORTESE, PATRICIA (LICSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:CORTESE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35382 US HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4754
Mailing Address - Country:US
Mailing Address - Phone:218-327-4886
Mailing Address - Fax:218-327-4848
Practice Address - Street 1:35382 US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-4754
Practice Address - Country:US
Practice Address - Phone:218-327-4886
Practice Address - Fax:218-327-4848
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2179103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN134T6COOtherBCBS MN