Healthcare Provider Details

I. General information

NPI: 1619420056
Provider Name (Legal Business Name): PATRICIA GEDAROVICH DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 06/22/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MAIN ST STE 2D
NORTH EASTON MA
02356-1469
US

IV. Provider business mailing address

11 LIBERTY RD
MEDFIELD MA
02052-3312
US

V. Phone/Fax

Practice location:
  • Phone: 508-238-7766
  • Fax:
Mailing address:
  • Phone: 774-277-0208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN01434
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN183995
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: