Provider Demographics
NPI:1073636783
Name:CZESAK, KATHERINE DOROTHY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:DOROTHY
Last Name:CZESAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 NEW MONTGOMERY ST
Mailing Address - Street 2:SUITE 424
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-3412
Mailing Address - Country:US
Mailing Address - Phone:415-495-5566
Mailing Address - Fax:510-451-0451
Practice Address - Street 1:55 NEW MONTGOMERY ST
Practice Address - Street 2:SUITE 424
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-3412
Practice Address - Country:US
Practice Address - Phone:415-495-5566
Practice Address - Fax:510-451-0451
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 11394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical