Provider Demographics
NPI:1801015227
Name:BENNETT-DEGUZMAN, PATTI A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATTI
Middle Name:A
Last Name:BENNETT-DEGUZMAN
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 1:11515 EL CAMINO REAL
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3038
Mailing Address - Country:US
Mailing Address - Phone:619-838-5989
Mailing Address - Fax:858-356-0412
Practice Address - Street 1:11515 EL CAMINO REAL
Practice Address - Street 2:SUITE 160
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3038
Practice Address - Country:US
Practice Address - Phone:619-838-5989
Practice Address - Fax:858-356-0412
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical