Provider Demographics
NPI:1528119948
Name:BORNO, PATRICIA KATHRYN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:KATHRYN
Last Name:BORNO
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 1:6645 VINELAND RD
Mailing Address - Street 2:250
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7841
Mailing Address - Country:US
Mailing Address - Phone:407-363-6779
Mailing Address - Fax:407-363-6830
Practice Address - Street 1:6645 VINELAND RD
Practice Address - Street 2:250
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7841
Practice Address - Country:US
Practice Address - Phone:407-363-6779
Practice Address - Fax:407-363-6830
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW38721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8224CMedicare ID - Type Unspecified