Healthcare Provider Details

I. General information

NPI: 1831272418
Provider Name (Legal Business Name): MARY ELLEN PATTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 WHITECHAPEL DR
VIRGINIA BEACH VA
23455
US

IV. Provider business mailing address

1532 ORCHARD GROVE DR
CHESAPEAKE VA
23320-1407
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-4655
  • Fax:
Mailing address:
  • Phone: 757-332-4839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003758
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: