Provider Demographics
NPI:1225463409
Name:KELLY, CATHERINE JAMESON LEE
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:JAMESON LEE
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:JAMESON LEE
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1750 PRAIRIE CITY RD # 130-296
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-9595
Mailing Address - Country:US
Mailing Address - Phone:209-553-0454
Mailing Address - Fax:
Practice Address - Street 1:1750 PRAIRIE CITY RD # 130-296
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-9595
Practice Address - Country:US
Practice Address - Phone:209-553-0454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30952103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical