Provider Demographics
NPI:1295741692
Name:CATSOS, PATRICIA DANEHY (MS, RD, LD)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:DANEHY
Last Name:CATSOS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:DANEHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:PO BOX 10106
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-0106
Mailing Address - Country:US
Mailing Address - Phone:207-318-7629
Mailing Address - Fax:
Practice Address - Street 1:21 WAVERLY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3313
Practice Address - Country:US
Practice Address - Phone:207-318-7629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI860133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
11564280OtherCAQH
1243064OtherAETNA
100285OtherBC BS