Provider Demographics
NPI:1528316221
Name:NIETSCH, PATRICIA C (MSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:C
Last Name:NIETSCH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ELIZABETH STREET
Mailing Address - Street 2:LOWER NAUGATUCK VALLEY PARENT CHILD RESOURCE CENTER, IN
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418
Mailing Address - Country:US
Mailing Address - Phone:203-954-0543
Mailing Address - Fax:203-954-0544
Practice Address - Street 1:30 ELIZABETH STREET
Practice Address - Street 2:LOWER NAUGATUCK VALLEY PARENT CHILD RESOURCE CENTER, IN
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418
Practice Address - Country:US
Practice Address - Phone:203-954-0543
Practice Address - Fax:203-954-0544
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004039541Medicaid