Provider Demographics
NPI:1861543266
Name:DE SEAR, PATRICIA HEALY (PHD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:HEALY
Last Name:DE SEAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 E RIDGEWOOD AVE
Mailing Address - Street 2:SUITE # 10
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3936
Mailing Address - Country:US
Mailing Address - Phone:201-652-7141
Mailing Address - Fax:
Practice Address - Street 1:1172 E RIDGEWOOD AVE
Practice Address - Street 2:SUITE # 10
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3936
Practice Address - Country:US
Practice Address - Phone:201-652-7141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3537103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ024138Medicare ID - Type UnspecifiedPSYCHOLOGIST