Provider Demographics
NPI:1063745776
Name:SURMANN, PATRIA MADELEINE (LMFT)
Entity type:Individual
Prefix:
First Name:PATRIA
Middle Name:MADELEINE
Last Name:SURMANN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:PATTY
Other - Middle Name:M
Other - Last Name:SURMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1450 CIVIC CT STE 200
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-7955
Mailing Address - Country:US
Mailing Address - Phone:925-671-0777
Mailing Address - Fax:925-685-0377
Practice Address - Street 1:2191 KIRKER PASS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-1629
Practice Address - Country:US
Practice Address - Phone:925-671-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA85765106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health