Provider Demographics
NPI:1912783556
Name:PATTERSON, MARVA DENISE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MARVA
Middle Name:DENISE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LMSW
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 380592
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06138-0592
Mailing Address - Country:US
Mailing Address - Phone:860-484-1511
Mailing Address - Fax:
Practice Address - Street 1:210 WETHERSFIELD AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1113
Practice Address - Country:US
Practice Address - Phone:860-296-0094
Practice Address - Fax:860-206-1184
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
CT7429101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral