Provider Demographics
NPI:1275719858
Name:PATTERSON, KASI GABRIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:KASI
Middle Name:GABRIEL
Last Name:PATTERSON
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 1:5890 S PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5937
Mailing Address - Country:US
Mailing Address - Phone:954-909-0888
Mailing Address - Fax:
Practice Address - Street 1:5890 S PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5937
Practice Address - Country:US
Practice Address - Phone:954-909-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty