Provider Demographics
NPI:1811205701
Name:FATATO, ANTOINETTE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:
Last Name:FATATO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:
Other - Last Name:FATATO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4335 MARINA CITY DR.
Mailing Address - Street 2:#136
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292
Mailing Address - Country:US
Mailing Address - Phone:424-228-5394
Mailing Address - Fax:
Practice Address - Street 1:4335 MARINA CITY DR
Practice Address - Street 2:UNIT 136 (ETS)
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5800
Practice Address - Country:US
Practice Address - Phone:424-228-5394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28450104100000X, 1041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator