Healthcare Provider Details

I. General information

NPI: 1245838556
Provider Name (Legal Business Name): PATRICIA GERONIMO M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA AMOROSO LMFT

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 COTTLE RD BLDG 24
SAN JOSE CA
95123-3640
US

IV. Provider business mailing address

5755 COTTLE RD BLDG 24
SAN JOSE CA
95123-3640
US

V. Phone/Fax

Practice location:
  • Phone: 369-209-7422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number142069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: