Provider Demographics
NPI:1720646938
Name:PATALANO, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:PATALANO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 QUAIL ST STE 135
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2719
Mailing Address - Country:US
Mailing Address - Phone:714-202-2100
Mailing Address - Fax:714-397-2562
Practice Address - Street 1:1000 QUAIL ST STE 135
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2719
Practice Address - Country:US
Practice Address - Phone:714-397-2562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT114226106H00000X, 101YM0800X
CALMFT128833106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist