Provider Demographics
NPI:1114472941
Name:PATT, KATHRYN DENISE
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:DENISE
Last Name:PATT
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 1:435 EDGEMAR AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1961
Mailing Address - Country:US
Mailing Address - Phone:650-877-8542
Mailing Address - Fax:
Practice Address - Street 1:435 EDGEMAR AVE
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1961
Practice Address - Country:US
Practice Address - Phone:650-877-8542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94763106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist