Active NPI
Larry M. Patrick, LICSW
- Clinical Social Worker
- Weirton, WV
National Provider Identifier
1518026780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- DP00454215
- Practice address
- 501 Colliers Way
Weirton, WV 26062-5003 - Phone
- (304) 723-5440
- Fax
- (304) 723-0665
- NPI assigned
- Dec 6, 2006
- Last updated
- May 26, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | DP00454215 | WV | Primary |
Addresses
Primary practice location
501 Colliers Way
Weirton, WV 26062-5003
Mailing address
501 Colliers Way
Weirton, WV 26062-5003
Phone (304) 723-5440
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0005456001 | Medicaid | WV | |
| 2070074 | Other | WV | CIGNA ID NUMBER |
| Y340644 | Other | WV | HEALTH PLAN ID NUMBER |
| 023533000 | Other | WV | MAGELLAN MIS NUMBER |
| 001718253 | Other | WV | MSBCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DP00454215 | WV | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274832000000",
"number": "1518026780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 COLLIERS WAY",
"city": "WEIRTON",
"state": "WV",
"postal_code": "260625003",
"telephone_number": "304-723-5440",
"fax_number": "304-723-0665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 COLLIERS WAY",
"city": "WEIRTON",
"state": "WV",
"postal_code": "260625003",
"telephone_number": "304-723-5440",
"fax_number": "304-723-0665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATRICK",
"first_name": "LARRY",
"middle_name": "M.",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-06",
"last_updated": "2010-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WV",
"license": "DP00454215",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0005456001",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA ID NUMBER",
"identifier": "2070074",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PLAN ID NUMBER",
"identifier": "Y340644",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN MIS NUMBER",
"identifier": "023533000",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MSBCBS",
"identifier": "001718253",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Weirton, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.