Provider Demographics
NPI:1902953532
Name:PATTERSON, RICHARD J (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 SW 5TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8600
Mailing Address - Country:US
Mailing Address - Phone:208-898-9755
Mailing Address - Fax:208-898-2544
Practice Address - Street 1:366 SW 5TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8600
Practice Address - Country:US
Practice Address - Phone:208-898-9755
Practice Address - Fax:208-898-2544
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW10151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDL5945OtherBLUE CROSS OF ID