Provider Demographics
NPI:1912046327
Name:PATERIK, RONALD E (MA)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:E
Last Name:PATERIK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11022 N 28TH DR STE 220
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5635
Mailing Address - Country:US
Mailing Address - Phone:602-942-2787
Mailing Address - Fax:602-942-3153
Practice Address - Street 1:11022 N 28TH DR STE 220
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5635
Practice Address - Country:US
Practice Address - Phone:602-942-2787
Practice Address - Fax:602-942-3153
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISA1449101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)