Provider Demographics
NPI:1720169527
Name:PAPE, PATRICIA A (PSYD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:PAPE
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 1:240 1ST AVE
Mailing Address - Street 2:#11D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2601
Mailing Address - Country:US
Mailing Address - Phone:561-329-9650
Mailing Address - Fax:212-842-0818
Practice Address - Street 1:240 1ST AVE
Practice Address - Street 2:#11D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2601
Practice Address - Country:US
Practice Address - Phone:561-329-9650
Practice Address - Fax:212-842-0818
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003532103T00000X
NY008021103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73235Medicare PIN
NYA300086761Medicare PIN