Provider Demographics
NPI:1346847613
Name:VIRGA, KATHERINE (LMFT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:VIRGA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 S BASCOM AVE STE 2400
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2356
Mailing Address - Country:US
Mailing Address - Phone:408-412-1861
Mailing Address - Fax:
Practice Address - Street 1:1875 S BASCOM AVE STE 2400
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2356
Practice Address - Country:US
Practice Address - Phone:408-412-1861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113323106H00000X
CA128391106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist