Provider Demographics
NPI:1245427913
Name:HENRIQUEZ, KATYA XOCHITL (MA)
Entity Type:Individual
Prefix:MS
First Name:KATYA
Middle Name:XOCHITL
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 EL CAMINO REAL STE 406
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3117
Mailing Address - Country:US
Mailing Address - Phone:650-652-0598
Mailing Address - Fax:650-652-0596
Practice Address - Street 1:1860 EL CAMINO REAL STE 406
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3117
Practice Address - Country:US
Practice Address - Phone:650-652-0598
Practice Address - Fax:650-652-0596
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78321106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist