Provider Demographics
NPI:1457802621
Name:PATRICIO, JADELL (MSW)
Entity Type:Individual
Prefix:
First Name:JADELL
Middle Name:
Last Name:PATRICIO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 GRAND PAVILION DR UNIT 104
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3720
Mailing Address - Country:US
Mailing Address - Phone:954-598-5334
Mailing Address - Fax:
Practice Address - Street 1:1412 TECH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7865
Practice Address - Country:US
Practice Address - Phone:727-593-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP362430919580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health