Provider Demographics
NPI:1427180140
Name:PARK, PATTI J (LCSW)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:J
Last Name:PARK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S GLENOAKS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1474
Mailing Address - Country:US
Mailing Address - Phone:818-441-7800
Mailing Address - Fax:
Practice Address - Street 1:601 S GLENOAKS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1474
Practice Address - Country:US
Practice Address - Phone:818-441-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical