Provider Demographics
NPI:1528089554
Name:SENIOR, PATRICIA M (RNCS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:SENIOR
Suffix:
Gender:F
Credentials:RNCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 LAKE AVE N STE 101
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2073
Mailing Address - Country:US
Mailing Address - Phone:508-753-3220
Mailing Address - Fax:508-753-3224
Practice Address - Street 1:425 LAKE AVE N STE 101
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2073
Practice Address - Country:US
Practice Address - Phone:508-753-3220
Practice Address - Fax:508-753-3224
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA129145364SA2200X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NS0501Medicare PIN
MANS0501Medicare ID - Type Unspecified