Provider Demographics
NPI:1104971902
Name:LENTZ, PATRICIA E (LICSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
Last Name:LENTZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:E
Other - Last Name:MCLAUGHLIN-LENTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:20 RESEARCH PKWY
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-4214
Mailing Address - Country:US
Mailing Address - Phone:800-370-3651
Mailing Address - Fax:860-510-0020
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:WELD BUILDING, FIRST FLOOR
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4800
Practice Address - Country:US
Practice Address - Phone:800-370-3651
Practice Address - Fax:860-510-0020
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW003361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
21045-2OtherBLUE CHIP
404628OtherBLUE CHIP