Provider Demographics
NPI:1679216980
Name:PATTISON, DAVID ELLIOTT
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ELLIOTT
Last Name:PATTISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 GOODALE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2783
Mailing Address - Country:US
Mailing Address - Phone:973-479-1415
Mailing Address - Fax:
Practice Address - Street 1:70 GOODALE RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2783
Practice Address - Country:US
Practice Address - Phone:973-479-1415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00693600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health