Provider Demographics
NPI:1821217050
Name:PATTERSON, BETHANY L (MED)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:L
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:L
Other - Last Name:STUART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2600
Mailing Address - Country:US
Mailing Address - Phone:617-534-3134
Mailing Address - Fax:857-288-2315
Practice Address - Street 1:211 RIVER ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2727
Practice Address - Country:US
Practice Address - Phone:617-534-9327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18657101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional