Provider Demographics
NPI:1649681826
Name:PATTERSON, JAMES GORDON (LICSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GORDON
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 MOUNT AUBURN ST
Mailing Address - Street 2:TUFTS HEALTH PLAN - 3RD FLOOR
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1508
Mailing Address - Country:US
Mailing Address - Phone:617-314-4048
Mailing Address - Fax:
Practice Address - Street 1:461 WASHINGTON ST APT 303
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2650
Practice Address - Country:US
Practice Address - Phone:617-314-4048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker