Provider Demographics
NPI:1538383153
Name:TIDWELL, PATRICIA RUTH (LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:RUTH
Last Name:TIDWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 UNIVERSITY PL FL 8
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4513
Mailing Address - Country:US
Mailing Address - Phone:212-463-9778
Mailing Address - Fax:212-463-9770
Practice Address - Street 1:88 UNIVERSITY PL FL 8
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4513
Practice Address - Country:US
Practice Address - Phone:212-463-9778
Practice Address - Fax:212-463-9770
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053594-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical