Provider Demographics
NPI:1558570713
Name:KEATING-MCCUTCHEON, PATRICIA ANNE (MA, ATR- BC, LCAT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANNE
Last Name:KEATING-MCCUTCHEON
Suffix:
Gender:F
Credentials:MA, ATR- BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17154 GLADWIN AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1126
Mailing Address - Country:US
Mailing Address - Phone:718-969-3863
Mailing Address - Fax:
Practice Address - Street 1:17154 GLADWIN AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-1126
Practice Address - Country:US
Practice Address - Phone:718-969-3863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000635221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist