Provider Demographics
NPI:1669552741
Name:BARD, PATRICIA NELLYS (LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:NELLYS
Last Name:BARD
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 1:4 BAY LN
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11719-9745
Mailing Address - Country:US
Mailing Address - Phone:631-286-2340
Mailing Address - Fax:
Practice Address - Street 1:4 BAY LN
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11719-9745
Practice Address - Country:US
Practice Address - Phone:631-286-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0695591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical