Provider Demographics
NPI:1487782264
Name:LATHROP, PATRICIA A (PHD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:LATHROP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 CHATHAM LANE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221
Mailing Address - Country:US
Mailing Address - Phone:614-754-7648
Mailing Address - Fax:614-754-7648
Practice Address - Street 1:921 CHATHAM LANE
Practice Address - Street 2:SUITE 112
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221
Practice Address - Country:US
Practice Address - Phone:614-754-7648
Practice Address - Fax:614-754-7648
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6239103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicare UPIN