Provider Demographics
NPI:1003847021
Name:MUSCHIO, KATHLEEN MOSS (MA)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MOSS
Last Name:MUSCHIO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 CREEKSIDE DRIVE #240
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3888
Mailing Address - Country:US
Mailing Address - Phone:916-320-1505
Mailing Address - Fax:530-677-6696
Practice Address - Street 1:1580 CREEKSIDE DRIVE #240
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3888
Practice Address - Country:US
Practice Address - Phone:916-320-1505
Practice Address - Fax:530-677-6696
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38298106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist