Provider Demographics
NPI:1679854558
Name:PATTERSON, RENISHER BERNADINE (MHC)
Entity Type:Individual
Prefix:MRS
First Name:RENISHER
Middle Name:BERNADINE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 SEAGIRT BLVD APT 6D
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2933
Mailing Address - Country:US
Mailing Address - Phone:646-246-1984
Mailing Address - Fax:
Practice Address - Street 1:2033 SEAGIRT BLVD APT 6D
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2933
Practice Address - Country:US
Practice Address - Phone:917-216-1025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0053202101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health