Provider Demographics
NPI:1720283237
Name:PALAN, PATRICK JAMES (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JAMES
Last Name:PALAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 31ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2518
Mailing Address - Country:US
Mailing Address - Phone:612-789-5565
Mailing Address - Fax:
Practice Address - Street 1:5100 GAMBLE DR
Practice Address - Street 2:SUITE 100 MAIL STOP 31200A
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1521
Practice Address - Country:US
Practice Address - Phone:952-593-8777
Practice Address - Fax:952-595-6408
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN79391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical