Provider Demographics
NPI:1730379256
Name:LYTTLE, PATRICK JOSEPH (LCSW)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:LYTTLE
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:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-0219
Mailing Address - Country:US
Mailing Address - Phone:860-212-2962
Mailing Address - Fax:
Practice Address - Street 1:435 BUCKLAND RD
Practice Address - Street 2:C/O DR. SHAPIRO
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3720
Practice Address - Country:US
Practice Address - Phone:860-212-2962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0028021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical