Provider Demographics
NPI:1750893921
Name:PATTON, KIM A (LCSW)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:PATTON
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 1:6154 ROYAL LYTHAM DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3944
Mailing Address - Country:US
Mailing Address - Phone:561-305-3117
Mailing Address - Fax:
Practice Address - Street 1:6154 ROYAL LYTHAM DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3944
Practice Address - Country:US
Practice Address - Phone:561-305-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-28
Last Update Date:2017-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW141811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical