Provider Demographics
NPI:1366479792
Name:GORMLEY, PATRICIA (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GORMLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MAIN ST N # 129
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-3840
Mailing Address - Country:US
Mailing Address - Phone:203-745-2326
Mailing Address - Fax:203-519-7979
Practice Address - Street 1:43 SHERMAN HILL RD
Practice Address - Street 2:BLG D, SUITE 103
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3651
Practice Address - Country:US
Practice Address - Phone:203-745-2326
Practice Address - Fax:203-519-7979
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0025111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical