Provider Demographics
NPI:1124253265
Name:ANDRETTA, PATRICK G (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:G
Last Name:ANDRETTA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6421 BOOTH ST
Mailing Address - Street 2:UNIT 4B
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3048
Mailing Address - Country:US
Mailing Address - Phone:516-994-1630
Mailing Address - Fax:
Practice Address - Street 1:6421 BOOTH ST
Practice Address - Street 2:UNIT 4B
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3048
Practice Address - Country:US
Practice Address - Phone:516-994-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018541103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical