Basic Information
Provider Information
NPI: 1922611581
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CURRY-DELLOP
FirstName: PATRICE
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7547 PARK PROMENADE DR APT 1522
Address2:  
City: WINTER PARK
State: FL
PostalCode: 327928627
CountryCode: US
TelephoneNumber: 3212971484
FaxNumber:  
Practice Location
Address1: 2479 ALOMA AVE
Address2:  
City: WINTER PARK
State: FL
PostalCode: 327922541
CountryCode: US
TelephoneNumber: 4076576692
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/24/2020
LastUpdateDate: 08/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XISW13541FLY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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