Provider Demographics
NPI:1730714478
Name:CHILDRESS, PATRICIA MARY (LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MARY
Last Name:CHILDRESS
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 1:1095 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-3847
Mailing Address - Country:US
Mailing Address - Phone:239-357-0103
Mailing Address - Fax:
Practice Address - Street 1:1095 WHIPPOORWILL LN
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-3847
Practice Address - Country:US
Practice Address - Phone:239-357-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL161301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty