Healthcare Provider Details

I. General information

NPI: 1649767575
Provider Name (Legal Business Name): SUZANNE KAREN PATTERSON LCPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZANNE KAREN PICARD

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 MAIN ST STE 302
SPRINGVALE ME
04083-1872
US

IV. Provider business mailing address

122 SAND POND RD
SANFORD ME
04073-5135
US

V. Phone/Fax

Practice location:
  • Phone: 207-651-2817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberXL4793
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: