Provider Demographics
NPI: | 1306943642 |
---|---|
Name: | CREMA, KATHRYN CHIESA (PSYD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | KATHRYN |
Middle Name: | CHIESA |
Last Name: | CREMA |
Suffix: | |
Gender: | F |
Credentials: | PSYD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 500 HWY 89 NORTH |
Mailing Address - Street 2: | |
Mailing Address - City: | PRESCOTT |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 86313-5001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 928-445-4861 |
Mailing Address - Fax: | 928-776-6125 |
Practice Address - Street 1: | 500 HWY 89 NORTH |
Practice Address - Street 2: | |
Practice Address - City: | PRESCOTT |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 86313-5001 |
Practice Address - Country: | US |
Practice Address - Phone: | 928-445-4861 |
Practice Address - Fax: | 928-776-6125 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-20 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 3448 | 103G00000X, 103TC0700X, 103TH0100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | |
Not Answered | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
Not Answered | 103TH0100X | Behavioral Health & Social Service Providers | Psychologist | Health Service |