Provider Demographics
NPI:1376223164
Name:SOPP, KATHLEEN CORINNE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CORINNE
Last Name:SOPP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 ROCKEFELLER LN UNIT C
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4697
Mailing Address - Country:US
Mailing Address - Phone:562-233-6770
Mailing Address - Fax:
Practice Address - Street 1:3605 LONG BEACH BLVD STE 330B
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4013
Practice Address - Country:US
Practice Address - Phone:562-233-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical