Healthcare Provider Details

I. General information

NPI: 1730248857
Provider Name (Legal Business Name): MARY CATHERINE PATOCK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 WATT AVE STE. 150
SACRAMENTO CA
95821-6237
US

IV. Provider business mailing address

2829 WATT AVE STE. 150
SACRAMENTO CA
95821-6237
US

V. Phone/Fax

Practice location:
  • Phone: 916-979-3536
  • Fax:
Mailing address:
  • Phone: 916-979-3536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY18231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: