Provider Demographics
NPI:1356508519
Name:BAGNALL, PATRICIA GRACE (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:GRACE
Last Name:BAGNALL
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 1:333 PEARL ST
Mailing Address - Street 2:APT. 6E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-1609
Mailing Address - Country:US
Mailing Address - Phone:917-597-1486
Mailing Address - Fax:
Practice Address - Street 1:250 WEST 57TH ST.
Practice Address - Street 2:SUITE 501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:917-597-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0523391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3545037OtherOXFORD