Provider Demographics
NPI:1225689680
Name:SOLOVIEFF MARTIN, KATHERINE (INTERN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SOLOVIEFF MARTIN
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 CARLOS DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2005
Mailing Address - Country:US
Mailing Address - Phone:415-473-4137
Mailing Address - Fax:
Practice Address - Street 1:13 PETER BEHR DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-5216
Practice Address - Country:US
Practice Address - Phone:415-473-4137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1355280719101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)