Basic Information
| Provider Information | |||||||||
| NPI: | 1063660959 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATANE | ||||||||
| FirstName: | JOLEEN | ||||||||
| MiddleName: | LINDA | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 428 | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346560428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278414200 | ||||||||
| FaxNumber: | 7278414354 | ||||||||
| Practice Location | |||||||||
| Address1: | 7074 GROVE RD | ||||||||
| Address2: | |||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346098658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525409335 | ||||||||
| FaxNumber: | 3525440722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2008 | ||||||||
| LastUpdateDate: | 09/04/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW 2389 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.