Provider Demographics
NPI:1528263019
Name:PATOLOT, MADELINE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:PATOLOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 N WILTON PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-4057
Mailing Address - Country:US
Mailing Address - Phone:323-466-5654
Mailing Address - Fax:310-576-2499
Practice Address - Street 1:1527 4TH ST
Practice Address - Street 2:STE 200
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2358
Practice Address - Country:US
Practice Address - Phone:310-576-2550
Practice Address - Fax:310-576-2499
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health