Basic Information
| Provider Information | |||||||||
| NPI: | 1720090426 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FINKENBERG | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | JOY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3262 JOHN BARTRAM PL | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294667083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438564143 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 204 W HILL BLVD | ||||||||
| Address2: | 437 MDOS/SGOH | ||||||||
| City: | CHARLESTON AFB | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294044704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439636972 | ||||||||
| FaxNumber: | 8439636501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | C003652 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | C003652 | 01 | NC | LCSW | OTHER |