Provider Demographics
NPI:1376542985
Name:DITTON, PATRICIA G (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:G
Last Name:DITTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6621 ELVERTON DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1177
Mailing Address - Country:US
Mailing Address - Phone:510-339-8458
Mailing Address - Fax:510-339-3902
Practice Address - Street 1:2428 DWIGHT WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-3503
Practice Address - Country:US
Practice Address - Phone:510-339-8458
Practice Address - Fax:510-339-3902
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9483103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPY0094830Medicaid
CAPY0094830Medicaid