Provider Demographics
NPI:1972670602
Name:PATTEN, SUSAN L (LIC AC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:PATTEN
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-3103
Mailing Address - Country:US
Mailing Address - Phone:978-462-7192
Mailing Address - Fax:
Practice Address - Street 1:166 WATER ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3144
Practice Address - Country:US
Practice Address - Phone:978-462-7192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216065171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist