Provider Demographics
NPI:1245381623
Name:MACDONALD, KATHERINE BDZIL (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:BDZIL
Last Name:MACDONALD
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 1:5725 MEADOWS DEL MAR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4869
Mailing Address - Country:US
Mailing Address - Phone:858-750-0009
Mailing Address - Fax:866-335-3533
Practice Address - Street 1:5725 MEADOWS DEL MAR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-4869
Practice Address - Country:US
Practice Address - Phone:858-750-0009
Practice Address - Fax:866-335-3533
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21345103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical