Provider Demographics
NPI:1831387067
Name:PATTERSON, LENWOOD VALENTINO
Entity type:Individual
Prefix:
First Name:LENWOOD
Middle Name:VALENTINO
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E OCEAN BLVD APT 1406
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-6139
Mailing Address - Country:US
Mailing Address - Phone:213-675-9016
Mailing Address - Fax:323-563-9333
Practice Address - Street 1:512 REDONDO AVE # C-1
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-1552
Practice Address - Country:US
Practice Address - Phone:213-675-9016
Practice Address - Fax:323-563-9333
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW69529104100000X
CAASW26884104100000X
1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker