Provider Demographics
NPI:1497801948
Name:FAIR, PATRICIA L (LICSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:L
Last Name:FAIR
Suffix:
Gender:F
Credentials:LICSW
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 91
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02060
Mailing Address - Country:US
Mailing Address - Phone:781-710-5837
Mailing Address - Fax:
Practice Address - Street 1:200 CORDWAINER DR
Practice Address - Street 2:STE 202
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1671
Practice Address - Country:US
Practice Address - Phone:781-383-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0207001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAD06058Medicare ID - Type Unspecified