Provider Demographics
NPI:1053738617
Name:PATINO, LESLIE (CO60273571)
Entity type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:
Last Name:PATINO
Suffix:
Gender:M
Credentials:CO60273571
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 VIRGINIA ST
Mailing Address - Street 2:210
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1439
Mailing Address - Country:US
Mailing Address - Phone:206-470-3856
Mailing Address - Fax:
Practice Address - Street 1:1100 VIRGINIA ST
Practice Address - Street 2:210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1439
Practice Address - Country:US
Practice Address - Phone:206-470-3856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60273571101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)