Provider Demographics
NPI:1841285186
Name:SHECK, PATRICIA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:SHECK
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:MARCIA CURTS
Mailing Address - Street 2:102 NORTH POINTE DRIVE
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823
Mailing Address - Country:US
Mailing Address - Phone:863-412-7591
Mailing Address - Fax:863-333-0550
Practice Address - Street 1:5110 SOUTH FLORIDA AVENUE
Practice Address - Street 2:SUITE #105
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3512
Practice Address - Country:US
Practice Address - Phone:863-608-9392
Practice Address - Fax:863-333-0550
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 64811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010779900Medicaid
FL006036700Medicaid
FL010779900Medicaid