Provider Demographics
NPI:1336380468
Name:PATTERSON, GREG R (LCPC)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:R
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04654-6041
Mailing Address - Country:US
Mailing Address - Phone:207-255-4545
Mailing Address - Fax:
Practice Address - Street 1:19 LYONS ST
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-1153
Practice Address - Country:US
Practice Address - Phone:207-255-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3234101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional