Provider Demographics
NPI:1205872322
Name:HYDOCK, PATRICIA A (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:A
Last Name:HYDOCK
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 1:639 LUZERNE ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-2327
Mailing Address - Country:US
Mailing Address - Phone:814-536-0798
Mailing Address - Fax:814-536-5746
Practice Address - Street 1:639 LUZERNE ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2327
Practice Address - Country:US
Practice Address - Phone:814-536-0798
Practice Address - Fax:814-536-5746
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW007057L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA628296OtherBLUE CROSS PROVIDER #