Provider Demographics
NPI:1932264124
Name:PATEL, VARSHA B (SOCIALWORKER)
Entity Type:Individual
Prefix:MRS
First Name:VARSHA
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:SOCIALWORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 TARA LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2337
Mailing Address - Country:US
Mailing Address - Phone:631-786-8040
Mailing Address - Fax:516-845-7082
Practice Address - Street 1:399 CONKLIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2614
Practice Address - Country:US
Practice Address - Phone:631-786-8040
Practice Address - Fax:516-845-7082
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO394801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYND9701Medicare ID - Type Unspecified