Healthcare Provider Details

I. General information

NPI: 1063745776
Provider Name (Legal Business Name): PATRIA MADELEINE SURMANN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. PATTY M SURMANN

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 KIRKER PASS RD
CONCORD CA
94521-1629
US

IV. Provider business mailing address

1450 CIVIC CT STE 200
CONCORD CA
94520-7955
US

V. Phone/Fax

Practice location:
  • Phone: 925-671-0777
  • Fax:
Mailing address:
  • Phone: 925-671-0777
  • Fax: 925-685-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number85765
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: