Provider Demographics
NPI:1942818190
Name:CARSON, PATRICIA ELLEN (MA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELLEN
Last Name:CARSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ELLEN
Other - Last Name:DOVZAK BYRNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:802 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-2306
Mailing Address - Country:US
Mailing Address - Phone:518-828-4886
Mailing Address - Fax:
Practice Address - Street 1:802 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-2306
Practice Address - Country:US
Practice Address - Phone:518-828-4886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker