Provider Demographics
NPI:1124286323
Name:ANTIN, PATRICIA KAY (MSW,PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:KAY
Last Name:ANTIN
Suffix:
Gender:F
Credentials:MSW,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 W OLYMPIC BLVD
Mailing Address - Street 2:STE. 501
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1524
Mailing Address - Country:US
Mailing Address - Phone:310-479-3130
Mailing Address - Fax:310-452-0225
Practice Address - Street 1:11500 W OLYMPIC BLVD
Practice Address - Street 2:STE. 501
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1524
Practice Address - Country:US
Practice Address - Phone:310-479-3130
Practice Address - Fax:310-452-0225
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALSC5238102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst