Provider Demographics
NPI:1790981140
Name:FIAMENGO, PATRICIA JOANNE (LCSW, M-RAS)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JOANNE
Last Name:FIAMENGO
Suffix:
Gender:F
Credentials:LCSW, M-RAS
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 4967
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92052-4967
Mailing Address - Country:US
Mailing Address - Phone:760-822-2207
Mailing Address - Fax:209-806-8686
Practice Address - Street 1:5083 SLEEPING INDIAN RD
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028
Practice Address - Country:US
Practice Address - Phone:760-822-2207
Practice Address - Fax:209-806-8686
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA992911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health