Provider Demographics
NPI:1306254149
Name:PATRICIA DECESARE LLC
Entity type:Organization
Organization Name:PATRICIA DECESARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DECESARE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:240-235-6560
Mailing Address - Street 1:19560 CLUB HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3002
Mailing Address - Country:US
Mailing Address - Phone:301-366-0825
Mailing Address - Fax:
Practice Address - Street 1:19560 CLUB HOUSE RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-3002
Practice Address - Country:US
Practice Address - Phone:240-235-6560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty