Provider Demographics
NPI:1801015011
Name:POWELL, PATRICIA ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:POWELL
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 1:5820 N FEDERAL HWY
Mailing Address - Street 2:SUITE A1
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-4003
Mailing Address - Country:US
Mailing Address - Phone:561-699-1374
Mailing Address - Fax:561-241-9210
Practice Address - Street 1:5820 N FEDERAL HWY
Practice Address - Street 2:SUITE A1
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-4003
Practice Address - Country:US
Practice Address - Phone:561-699-1374
Practice Address - Fax:561-241-9210
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 71761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ088JOtherBLUE CROSS PROVIDER NUMBE
FLZ088JOtherBLUE CROSS PROVIDER NUMBE