Provider Demographics
NPI:1265658454
Name:MANETTA, KATHRYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:MANETTA
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 1:6615 E PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 255
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4211
Mailing Address - Country:US
Mailing Address - Phone:562-799-6700
Mailing Address - Fax:562-799-6733
Practice Address - Street 1:6615 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE 255
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4211
Practice Address - Country:US
Practice Address - Phone:562-799-6700
Practice Address - Fax:562-799-6733
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22795103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist