Provider Demographics
NPI:1588700223
Name:EVERETT, PATRICIA R (PH D)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:R
Last Name:EVERETT
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 N PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1717
Mailing Address - Country:US
Mailing Address - Phone:413-256-3539
Mailing Address - Fax:
Practice Address - Street 1:96 N PLEASANT ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1717
Practice Address - Country:US
Practice Address - Phone:413-256-3539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5082103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04787OtherBLUE CROSS BLUE SHIELD