Provider Demographics
NPI:1801165162
Name:ANDRADA, PATSY (MSW, LISW)
Entity type:Individual
Prefix:MS
First Name:PATSY
Middle Name:
Last Name:ANDRADA
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 S SUNSET AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2808
Mailing Address - Country:US
Mailing Address - Phone:626-338-9000
Mailing Address - Fax:626-338-9022
Practice Address - Street 1:16465 SIERRA LAKES PKWY STE 145
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1242
Practice Address - Country:US
Practice Address - Phone:909-725-4742
Practice Address - Fax:909-752-9275
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM208000000X2080A0000X
CA174551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine