Provider Demographics
NPI:1720091259
Name:MCPHATTER, E ANNETTE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:E ANNETTE
Middle Name:
Last Name:MCPHATTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66384
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23466-6384
Mailing Address - Country:US
Mailing Address - Phone:631-334-3341
Mailing Address - Fax:
Practice Address - Street 1:4544 COLUMBUS STREET
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7549
Practice Address - Country:US
Practice Address - Phone:631-334-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016335-1103TC0700X
NY016335103TC0700X
VA0810003920103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical