Provider Demographics
NPI:1649767575
Name:PATTERSON, SUZANNE KAREN (LCPC-C)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:KAREN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:KAREN
Other - Last Name:PICARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 SAND POND RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-5135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:469 MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1872
Practice Address - Country:US
Practice Address - Phone:207-651-2817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health