Provider Demographics
NPI:1063626828
Name:PATTERSON, CAROL A (MED)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-0608
Mailing Address - Country:US
Mailing Address - Phone:724-836-3980
Mailing Address - Fax:724-850-8441
Practice Address - Street 1:161 OLD STATE ROUTE 30
Practice Address - Street 2:UNIT 14
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7553
Practice Address - Country:US
Practice Address - Phone:724-836-3980
Practice Address - Fax:724-850-8441
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA003173103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist