Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 018613-1 | NY |
Y | 103T00000X | Psychologist | 018613-1 | NY |
NPI | 1013424803 |
---|---|
Provider Name | Randy E Patterson |
First Address | Ithaca, NY 14853-3102 |
Second Address | Ithaca, NY 14853-3102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2018 |
Last Update Date | 03/01/2018 |