Provider Demographics
NPI:1053504472
Name:AGREDANO, PATRICE E
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:E
Last Name:AGREDANO
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 1:1451 ROCKY RIDGE DR APT 1109
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3007
Mailing Address - Country:US
Mailing Address - Phone:916-320-2503
Mailing Address - Fax:916-283-8259
Practice Address - Street 1:212 I ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4213
Practice Address - Country:US
Practice Address - Phone:530-601-5959
Practice Address - Fax:916-287-4679
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102263106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist