Provider Demographics
NPI:1689952848
Name:LOPATA, WENDY M (LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:LOPATA
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 1:107 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2010
Mailing Address - Country:US
Mailing Address - Phone:323-634-4711
Mailing Address - Fax:
Practice Address - Street 1:107 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 313
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2010
Practice Address - Country:US
Practice Address - Phone:323-634-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 267711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical