Provider Demographics
NPI:1831374271
Name:PATT, IVY S (PHD)
Entity type:Individual
Prefix:DR
First Name:IVY
Middle Name:S
Last Name:PATT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LASALLE RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2322
Mailing Address - Country:US
Mailing Address - Phone:860-810-0587
Mailing Address - Fax:860-678-7123
Practice Address - Street 1:125 LASALLE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2322
Practice Address - Country:US
Practice Address - Phone:860-810-0587
Practice Address - Fax:860-678-7123
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002811103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist