Provider Demographics
NPI:1487655916
Name:JARRETT, PATRICIA J (MD, PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:JARRETT
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HILLVUE DR
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-3426
Mailing Address - Country:US
Mailing Address - Phone:724-287-0791
Mailing Address - Fax:724-287-2730
Practice Address - Street 1:112 HILLVUE DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-3426
Practice Address - Country:US
Practice Address - Phone:724-287-0791
Practice Address - Fax:724-287-2730
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 039457E101YP2500X
PAMD039457E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012111530001Medicaid
PA0012111530001Medicaid