Provider Demographics
NPI:1790981140
Name:FIAMENGO, PATRICIA JOANNE (LCSW, M-RAS)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JOANNE
Last Name:FIAMENGO
Suffix:
Gender:F
Credentials:LCSW, M-RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 E ELDER ST STE A
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-5000
Mailing Address - Country:US
Mailing Address - Phone:760-420-1683
Mailing Address - Fax:866-511-7554
Practice Address - Street 1:593 E ELDER ST STE A
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-5000
Practice Address - Country:US
Practice Address - Phone:760-420-1683
Practice Address - Fax:866-511-7554
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA992911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1508505009OtherFIAMENGO & ASSOCIATES MENTAL HEALTH COUNSELING AND COACHING