Provider Demographics
NPI:1083733141
Name:HODGMAN, PATRISHA LOUISE
Entity Type:Individual
Prefix:
First Name:PATRISHA
Middle Name:LOUISE
Last Name:HODGMAN
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 1:44738 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3016
Mailing Address - Country:US
Mailing Address - Phone:661-400-7295
Mailing Address - Fax:661-974-7966
Practice Address - Street 1:44738 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3016
Practice Address - Country:US
Practice Address - Phone:661-400-7295
Practice Address - Fax:661-974-7966
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42587106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist