Provider Demographics
NPI:1407114838
Name:HATCH, KATHARINE DOUGLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:DOUGLAS
Last Name:HATCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BAYVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-4931
Mailing Address - Country:US
Mailing Address - Phone:512-565-9828
Mailing Address - Fax:
Practice Address - Street 1:700 E ST STE 207
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2756
Practice Address - Country:US
Practice Address - Phone:415-419-3539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20991103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling