Provider Demographics
NPI:1346823788
Name:BECKWITH, KATHERINE ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:BECKWITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:DOROCIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:488 WINSLOW ST APT 502
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1878
Mailing Address - Country:US
Mailing Address - Phone:941-284-9648
Mailing Address - Fax:
Practice Address - Street 1:488 WINSLOW ST APT 502
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1878
Practice Address - Country:US
Practice Address - Phone:941-284-9648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32528103G00000X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical