Provider Demographics
NPI:1740536069
Name:PATT, LESLIE ALAN (MS)
Entity type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:ALAN
Last Name:PATT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2436 COTTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-4009
Mailing Address - Country:US
Mailing Address - Phone:408-438-0455
Mailing Address - Fax:408-667-3279
Practice Address - Street 1:2436 COTTLE AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-4009
Practice Address - Country:US
Practice Address - Phone:408-438-0455
Practice Address - Fax:408-667-3279
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC17513106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist