Healthcare Provider Details

I. General information

NPI: 1720764848
Provider Name (Legal Business Name): KWAN PATTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KEISHA KWAN PATTON LPC

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 WASHINGTON BLVD SUITE 207
STAMFORD CT
06902
US

IV. Provider business mailing address

P.O. BOX 44
STAMFORD CT
06904
US

V. Phone/Fax

Practice location:
  • Phone: 475-449-7500
  • Fax:
Mailing address:
  • Phone: 475-449-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6521
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: