Patrice Fortune, PHD

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

80309 Issued in CA

Practice address

63 Bovet Road #221
San Mateo, CA 94402-3104

Phone

(650) 619-9942

NPI assigned

Jul 13, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Blue Lotus Connection

  • Point of Service
  • San Mateo, CA
  • NPI 1760997902
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1235368135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 BOVET ROAD #221",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944023104",
            "telephone_number": "650-999-6650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 BOVET ROAD #221",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944023104",
            "telephone_number": "650-619-9942"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1700 S Amphlett Blvd, Ste 250B",
            "address_purpose": "LOCATION",
            "city": "San Mateo",
            "state": "CA",
            "postal_code": "94402",
            "country_code": "US",
            "telephone_number": "650-619-9942",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "951 Mariners Island Blvd Ste 300",
            "address_purpose": "LOCATION",
            "city": "San Mateo",
            "state": "CA",
            "postal_code": "944041560",
            "country_code": "US",
            "telephone_number": "650-999-6650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORTUNE",
        "first_name": "PATRICE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-13",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSB 36721",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "80309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicola Forbes
• Lindsey Alana Force, M.D.
• Gordon Kevin Ford Jr.
• Rebecca Forrest
• William Robert Fortin
• Terrell Jason Fortune
• Lorna P Foster, PHD, CA PSY32594
• Madeline Mari Foster, LMFT
• Indu Fotedar, MD
• Kayla Deann Foucheaux

• Marriage & Family Therapist in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.