Provider Demographics
NPI:1417037458
Name:KATAYAMA, KYOKO (LICSW)
Entity Type:Individual
Prefix:DR
First Name:KYOKO
Middle Name:
Last Name:KATAYAMA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 BRANSTON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1434
Mailing Address - Country:US
Mailing Address - Phone:651-644-1298
Mailing Address - Fax:651-644-5064
Practice Address - Street 1:366 PRIOR AVE N
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5165
Practice Address - Country:US
Practice Address - Phone:651-644-2397
Practice Address - Fax:651-644-5064
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical