Provider Demographics
NPI:1770885105
Name:CHAN, PATRICIA CARMELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:CARMELLE
Last Name:CHAN
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 1:56 SADDLER LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-3419
Mailing Address - Country:US
Mailing Address - Phone:347-768-0866
Mailing Address - Fax:
Practice Address - Street 1:56 SADDLER LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-3419
Practice Address - Country:US
Practice Address - Phone:347-768-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0728261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical