Healthcare Provider Details

I. General information

NPI: 1447115852
Provider Name (Legal Business Name): PATRICK FANNON LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 7TH AVE # 10TH
NEW YORK NY
10019-6831
US

IV. Provider business mailing address

729 7TH AVE FL 10
NEW YORK NY
10019-6895
US

V. Phone/Fax

Practice location:
  • Phone: 818-445-3660
  • Fax:
Mailing address:
  • Phone: 818-445-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: PATRICK FANNON
Title or Position: OWNER
Credential: LCSW
Phone: 818-445-3660