Provider Demographics
NPI:1346890654
Name:PATTON, GREGORY (CASAC T)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:PATTON
Suffix:
Gender:M
Credentials:CASAC T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ANN ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-2716
Mailing Address - Country:US
Mailing Address - Phone:518-606-4150
Mailing Address - Fax:
Practice Address - Street 1:40 ANN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2716
Practice Address - Country:US
Practice Address - Phone:518-606-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35623101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY444542Medicaid
NY35623Medicaid