Provider Demographics
NPI:1649360959
Name:WALDECK, PATRICIA A (MSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:WALDECK
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 1:22 AXTELL DR
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5602
Mailing Address - Country:US
Mailing Address - Phone:914-725-4888
Mailing Address - Fax:914-725-2324
Practice Address - Street 1:22 AXTELL DR
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5602
Practice Address - Country:US
Practice Address - Phone:914-725-4888
Practice Address - Fax:914-725-2324
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO64383-11041C0700X
MA1049011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012867OtherVALUE OPTIONS
NYN734R1Medicare ID - Type Unspecified