Provider Demographics
NPI:1083052179
Name:RABAK, KATHRYN (ASW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:RABAK
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 I ST UNIT 203
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4421
Mailing Address - Country:US
Mailing Address - Phone:916-836-4099
Mailing Address - Fax:
Practice Address - Street 1:3101 I ST UNIT 203
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4421
Practice Address - Country:US
Practice Address - Phone:916-836-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 322D00000X
CAASW77746104100000X
CALCSW1019271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children