Provider Demographics
NPI:1790712735
Name:PATTERSON, JUDITH ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ELLEN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JCT
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-1603
Mailing Address - Country:US
Mailing Address - Phone:609-936-0514
Mailing Address - Fax:609-799-1813
Practice Address - Street 1:3 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON JCT
Practice Address - State:NJ
Practice Address - Zip Code:08550-1603
Practice Address - Country:US
Practice Address - Phone:609-936-0514
Practice Address - Fax:609-799-1813
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100315100103T00000X
NY011592-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPA763937Medicare ID - Type Unspecified