Provider Demographics
NPI:1396981130
Name:NAUSS, PATRICIA JEAN (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JEAN
Last Name:NAUSS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MRS
Other - First Name:TRISH
Other - Middle Name:J
Other - Last Name:NAUSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:21 SHAMROCK LN
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3057
Mailing Address - Country:US
Mailing Address - Phone:631-339-1326
Mailing Address - Fax:
Practice Address - Street 1:21 SHAMROCK LN
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-3057
Practice Address - Country:US
Practice Address - Phone:631-339-1326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077192104100000X
NY0861041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker