Provider Demographics
NPI:1598385817
Name:GRATSON, PATRICIA ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANNE
Last Name:GRATSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 N KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1701
Mailing Address - Country:US
Mailing Address - Phone:610-996-1587
Mailing Address - Fax:
Practice Address - Street 1:1518 WALNUT ST STE 307
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3402
Practice Address - Country:US
Practice Address - Phone:215-625-9655
Practice Address - Fax:215-625-8524
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019025103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist