Provider Demographics
NPI:1053612465
Name:LONERGAN, PATRICIA ELLEN (LMHC)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ELLEN
Last Name:LONERGAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1751
Mailing Address - Country:US
Mailing Address - Phone:508-835-1735
Mailing Address - Fax:508-835-1736
Practice Address - Street 1:148 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1751
Practice Address - Country:US
Practice Address - Phone:508-835-1735
Practice Address - Fax:508-835-1736
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7472101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health