Provider Demographics
NPI:1043964661
Name:PATTERSON, ALEXIS AYONA
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:AYONA
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 1:159 W SELDEN ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2321
Mailing Address - Country:US
Mailing Address - Phone:617-401-6626
Mailing Address - Fax:
Practice Address - Street 1:159 W SELDEN ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2321
Practice Address - Country:US
Practice Address - Phone:617-401-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician