Provider Demographics
NPI:1043376858
Name:PIERCE, KATHLEEN SUZANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:SUZANNE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 ASHBY AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1909
Mailing Address - Country:US
Mailing Address - Phone:510-495-4450
Mailing Address - Fax:
Practice Address - Street 1:2305 ASHBY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1909
Practice Address - Country:US
Practice Address - Phone:510-495-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20673103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical