Provider Demographics
NPI:1700948791
Name:OWEN, PATRICIA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:L
Last Name:OWEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5464 E SUNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3052
Mailing Address - Country:US
Mailing Address - Phone:559-978-6606
Mailing Address - Fax:
Practice Address - Street 1:1430 BLUE OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747
Practice Address - Country:US
Practice Address - Phone:559-978-6606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23163103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355940Medicaid
NY1285628552OtherAGENCY NPI
NYWVE061Medicare ID - Type UnspecifiedAGENCY MEDICARE PROVIDER#