Provider Demographics
NPI:1902099252
Name:WIGHTMAN, PATRICIA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:WIGHTMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3618
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33465-3618
Mailing Address - Country:US
Mailing Address - Phone:561-860-1512
Mailing Address - Fax:561-828-0189
Practice Address - Street 1:3951 N OCEAN BLVD
Practice Address - Street 2:#701
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-7469
Practice Address - Country:US
Practice Address - Phone:561-860-1512
Practice Address - Fax:561-828-0189
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0004134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health