Provider Demographics
NPI:1902951379
Name:OTTEN, PATRICE H (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:H
Last Name:OTTEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 SARATOGA AVE
Mailing Address - Street 2:S 210
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051
Mailing Address - Country:US
Mailing Address - Phone:408-920-2172
Mailing Address - Fax:408-248-9563
Practice Address - Street 1:160 SARATOGA AVE
Practice Address - Street 2:S 210
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051
Practice Address - Country:US
Practice Address - Phone:408-920-2172
Practice Address - Fax:408-248-9563
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical