MEDICARE: DR. JUDITH ELLEN PATTERSON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	35S100315100	NJ
2	103T00000X	Psychologist	011592-1	NY

General Provider Information

NPI Number	:	1790712735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH ELLEN PATTERSON PH.D.

Provider Business Mailing Address
First Line	:	3 COLONIAL AVE
Second Line	:
City	:	PRINCETON JCT
State	:	NJ
Zip	:	08550-1603
Country	:	US
Telephone Number	:	609-936-0514
Fax Number	:	609-799-1813

Provider Business Practice Location Address
First Line	:	3 COLONIAL AVE
Second Line	:
City	:	PRINCETON JCT
State	:	NJ
Zip	:	08550-1603
Country	:	US
Telephone Number	:	609-936-0514
Fax Number	:	609-799-1813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/08/2007

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