Healthcare Provider Details

I. General information

NPI: 1346307022
Provider Name (Legal Business Name): DIANE A. PATTERSON MS, MBA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ERDMAN WAY
LEOMINSTER MA
01453-1804
US

IV. Provider business mailing address

100 ERDMAN WAY
LEOMINSTER MA
01453-1804
US

V. Phone/Fax

Practice location:
  • Phone: 978-466-8390
  • Fax: 978-537-3496
Mailing address:
  • Phone: 978-466-8390
  • Fax: 978-537-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3789
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE-0003844
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: