Provider Demographics
NPI:1306329271
Name:WHITAKER, PATRICIA JANE (LICSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JANE
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:J
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:700 SHORE DR UNIT 807
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-1087
Mailing Address - Country:US
Mailing Address - Phone:508-676-3390
Mailing Address - Fax:
Practice Address - Street 1:MASAC-PLYMOUTH
Practice Address - Street 2:1 BUMPS POND ROAD
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360
Practice Address - Country:US
Practice Address - Phone:508-291-2441
Practice Address - Fax:508-291-2355
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1021861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical