Provider Demographics
NPI:1285799635
Name:GANDEK, PATRICE MACKARONIS (MSW)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:MACKARONIS
Last Name:GANDEK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 CHADWICK CT
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-1904
Mailing Address - Country:US
Mailing Address - Phone:925-351-5156
Mailing Address - Fax:925-688-2100
Practice Address - Street 1:391 TAYLOR BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2294
Practice Address - Country:US
Practice Address - Phone:925-688-8910
Practice Address - Fax:925-699-8910
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS74281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical