Provider Demographics
NPI:1205032067
Name:AHEARN-EDWARDS, KATHERINE C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:C
Last Name:AHEARN-EDWARDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:A
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4656 30TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-3247
Mailing Address - Country:US
Mailing Address - Phone:858-204-7976
Mailing Address - Fax:
Practice Address - Street 1:1630 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5204
Practice Address - Country:US
Practice Address - Phone:619-563-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical