Healthcare Provider Details

I. General information

NPI: 1790191419
Provider Name (Legal Business Name): PATTON PSYCHOLOGY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17501 BISCAYNE BLVD STE 450
AVENTURA FL
33160-4806
US

IV. Provider business mailing address

17501 BISCAYNE BLVD STE 450
AVENTURA FL
33160-4806
US

V. Phone/Fax

Practice location:
  • Phone: 786-519-1088
  • Fax: 305-933-5733
Mailing address:
  • Phone: 786-519-1088
  • Fax: 305-933-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY6970
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY6970
License Number StateFL

VIII. Authorized Official

Name: DR. DOYLE E PATTON
Title or Position: PRESIDENT/CLINICAL NEUROPSYCHOLOGIS
Credential: PH.D.
Phone: 786-519-1088