Provider Demographics
NPI:1013948207
Name:CORREA, PATRICIA P (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:P
Last Name:CORREA
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 LAS VIRGENES RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1956
Mailing Address - Country:US
Mailing Address - Phone:818-871-9500
Mailing Address - Fax:818-871-9550
Practice Address - Street 1:4505 LAS VIRGENES RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1956
Practice Address - Country:US
Practice Address - Phone:818-871-9500
Practice Address - Fax:818-871-9550
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34844106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11413912OtherCAQH