Provider Demographics
NPI:1275667222
Name:HARDISTY, KATHLEEN ONGBONGAN (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ONGBONGAN
Last Name:HARDISTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:TAN
Other - Last Name:ONGBONGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4141 GEARY BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3111
Mailing Address - Country:US
Mailing Address - Phone:415-833-3147
Mailing Address - Fax:
Practice Address - Street 1:4141 GEARY BLVD FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3111
Practice Address - Country:US
Practice Address - Phone:415-833-3147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 194671041C0700X
CALCS258911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical