Provider Demographics
NPI:1316270002
Name:LAMOUR, PATRICE (LICSW,CAGS)
Entity type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:
Last Name:LAMOUR
Suffix:
Gender:F
Credentials:LICSW,CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1241
Mailing Address - Country:US
Mailing Address - Phone:617-306-6828
Mailing Address - Fax:617-282-6776
Practice Address - Street 1:336 ADAMS ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1241
Practice Address - Country:US
Practice Address - Phone:617-306-6828
Practice Address - Fax:617-282-6776
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-12
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1142091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical