Provider Demographics
NPI:1053328104
Name:WARWICK-SMITH, KATHLEEN (MA, MFT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:WARWICK-SMITH
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4529
Mailing Address - Country:US
Mailing Address - Phone:707-527-9525
Mailing Address - Fax:707-938-3515
Practice Address - Street 1:862 3RD ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4529
Practice Address - Country:US
Practice Address - Phone:707-527-9525
Practice Address - Fax:707-938-3515
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC #40025106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist