Provider Demographics
NPI:1619377033
Name:PATTERSON, DOREEN (SPECIAL EDUCATOR)
Entity Type:Individual
Prefix:MISS
First Name:DOREEN
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:SPECIAL EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4260 MAIN STREET
Mailing Address - Street 2:5M
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4735
Mailing Address - Country:US
Mailing Address - Phone:718-463-3363
Mailing Address - Fax:
Practice Address - Street 1:4260 MAIN ST
Practice Address - Street 2:5M
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4709
Practice Address - Country:US
Practice Address - Phone:718-463-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist