Individual
DR. PATRICK JOHN DATTORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
100 N EDWARD GARY ST, SUITE 103B, SAN MARCOS, TX 78666-5726
(512) 392-9472
(512) 392-9472
Mailing address
100 N EDWARD GARY ST, SUITE 103B, SAN MARCOS, TX 78666-5726
(512) 392-9472
(512) 392-9472
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
31285
TX
103TC0700X
Clinical Psychologist
Primary
31285
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0091GZ
BLUE CROSS/SHIELD
TX
01
—
118398000
MAGELLAN
TX
05
—
1476715-01
—
TX
01
—
162291
COMPSYCH
TX
Enumeration date
06/10/2005
Last updated
12/10/2011
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