Individual
LARRY M. PATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
501 COLLIERS WAY, WEIRTON, WV 26062-5003
(304) 723-5440
(304) 723-0665
Mailing address
501 COLLIERS WAY, WEIRTON, WV 26062-5003
(304) 723-5440
(304) 723-0665
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
DP00454215
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005456001
—
WV
01
—
001718253
MSBCBS
WV
01
—
023533000
MAGELLAN MIS NUMBER
WV
01
—
2070074
CIGNA ID NUMBER
WV
01
—
Y340644
HEALTH PLAN ID NUMBER
WV
Enumeration date
12/06/2006
Last updated
05/26/2010
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