Healthcare Provider Details

I. General information

NPI: 1255627899
Provider Name (Legal Business Name): KATHRYN ANNA PATTERSON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 MAIN STREET
MIDDLETOWN CT
06457-2632
US

IV. Provider business mailing address

675 MAIN STREET
MIDDLETOWN CT
06457-2632
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-6971
  • Fax:
Mailing address:
  • Phone: 860-347-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3480
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3480
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: