Provider Demographics
NPI:1831763366
Name:PATTERSON-BANCROFT, VANESSA ROSE (LMSW)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ROSE
Last Name:PATTERSON-BANCROFT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5447 UPPER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-1811
Mailing Address - Country:US
Mailing Address - Phone:716-799-4581
Mailing Address - Fax:
Practice Address - Street 1:5447 UPPER MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-1811
Practice Address - Country:US
Practice Address - Phone:716-799-4581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106482104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker