Healthcare Provider Details

I. General information

NPI: 1720646938
Provider Name (Legal Business Name): MARY PATALANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 QUAIL ST STE 135
NEWPORT BEACH CA
92660-2719
US

IV. Provider business mailing address

1000 QUAIL ST STE 135
NEWPORT BEACH CA
92660-2719
US

V. Phone/Fax

Practice location:
  • Phone: 714-397-2562
  • Fax:
Mailing address:
  • Phone: 714-202-2100
  • Fax: 714-397-2562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT114226
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT128833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: