Provider Demographics
NPI:1700331592
Name:CARLSON, PATRICIA LOMBARDO (MFT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LOMBARDO
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 ALVARADO AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1216
Mailing Address - Country:US
Mailing Address - Phone:650-867-6893
Mailing Address - Fax:
Practice Address - Street 1:1059 EL MONTE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4601
Practice Address - Country:US
Practice Address - Phone:650-229-8591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53539106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist