Provider Demographics
NPI:1831366186
Name:PATAPIS, NICHOLAS STEPHEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:STEPHEN
Last Name:PATAPIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2081
Mailing Address - Country:US
Mailing Address - Phone:215-333-7562
Mailing Address - Fax:
Practice Address - Street 1:8400 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2081
Practice Address - Country:US
Practice Address - Phone:215-333-7562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015537103TA0400X, 103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1052629169Medicare PIN