Provider Demographics
NPI:1407936685
Name:HARGITT, KATHERINE FORRY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:FORRY
Last Name:HARGITT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:FORRY
Other - Last Name:HARGITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-0581
Mailing Address - Country:US
Mailing Address - Phone:707-235-8488
Mailing Address - Fax:
Practice Address - Street 1:250 BON AIR RD UNIT B
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:415-473-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CAPSY26539103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist