Provider Demographics
NPI:1912028572
Name:WALDO, PATRICIA G (LMFT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:G
Last Name:WALDO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 N KILKEA DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-2213
Mailing Address - Country:US
Mailing Address - Phone:818-404-0128
Mailing Address - Fax:
Practice Address - Street 1:4419 COLDWATER CANYON AVE STE C
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1478
Practice Address - Country:US
Practice Address - Phone:818-404-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37628106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist