Provider Demographics
NPI:1356821573
Name:FOLSOM, KASIA
Entity Type:Individual
Prefix:MRS
First Name:KASIA
Middle Name:
Last Name:FOLSOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KASIA
Other - Middle Name:MARIE
Other - Last Name:FOLSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1405 SPRUCE ST STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2410
Mailing Address - Country:US
Mailing Address - Phone:951-715-5050
Mailing Address - Fax:
Practice Address - Street 1:1405 SPRUCE ST STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2410
Practice Address - Country:US
Practice Address - Phone:951-715-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171M00000XOtherCOUNTY OF RIVERSIDE MENTAL HEALTH