Provider Demographics
NPI:1679314017
Name:PATTERSON, MALLORY RAE MICHELE
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:RAE MICHELE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075A MERCURY CIR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87116-3020
Mailing Address - Country:US
Mailing Address - Phone:228-243-5727
Mailing Address - Fax:
Practice Address - Street 1:6801 JEFFERSON ST NE STE 301
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-7390
Practice Address - Country:US
Practice Address - Phone:505-705-1701
Practice Address - Fax:505-212-1253
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator