Provider Demographics
NPI:1366039836
Name:HALL, PATRICK NORMAN (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:NORMAN
Last Name:HALL
Suffix:
Gender:M
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:RODOVIA FRANCISCO THOMAZ DOS SANTOS 8650
Mailing Address - Street 2:CASA 09
Mailing Address - City:PANTANO DO SUL
Mailing Address - State:SANTA CATARINA
Mailing Address - Zip Code:88067000
Mailing Address - Country:BR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 SANTO NINO RD
Practice Address - Street 2:
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529-6015
Practice Address - Country:US
Practice Address - Phone:505-397-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2024-07221041C0700X
NM1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78270847Medicaid