Provider Demographics
NPI:1124592415
Name:STOUGH, PATRICIA (LSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:STOUGH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 LEWISBERRY RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-1831
Mailing Address - Country:US
Mailing Address - Phone:717-873-3688
Mailing Address - Fax:
Practice Address - Street 1:41 E ORANGE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2846
Practice Address - Country:US
Practice Address - Phone:717-393-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-19
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135485104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker