Provider Demographics
NPI:1730248857
Name:PATOCK, MARY CATHERINE (PSYD)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CATHERINE
Last Name:PATOCK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 WATT AVE
Mailing Address - Street 2:STE. 150
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6237
Mailing Address - Country:US
Mailing Address - Phone:916-979-3536
Mailing Address - Fax:
Practice Address - Street 1:2829 WATT AVE
Practice Address - Street 2:STE. 150
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-6237
Practice Address - Country:US
Practice Address - Phone:916-979-3536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18231103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)