Provider Demographics
NPI:1114439577
Name:MORIN, PATRICIA LEE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEE
Last Name:MORIN
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:PO BOX 2220
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94966-2220
Mailing Address - Country:US
Mailing Address - Phone:415-328-1050
Mailing Address - Fax:
Practice Address - Street 1:347 EDEN ROC
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1361
Practice Address - Country:US
Practice Address - Phone:415-328-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO333651041C0700X
CALCSW870471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty