Provider Demographics
NPI:1457448466
Name:CANN, KATHRYN J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:J
Last Name:CANN
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 1:11344 COLOMA RD
Mailing Address - Street 2:STE. 250
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4457
Mailing Address - Country:US
Mailing Address - Phone:916-812-2989
Mailing Address - Fax:916-486-3771
Practice Address - Street 1:11344 COLOMA RD
Practice Address - Street 2:STE. 250
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4457
Practice Address - Country:US
Practice Address - Phone:916-812-2989
Practice Address - Fax:916-852-5838
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 15144101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA151140Medicaid
CAZZZ00055ZMedicare ID - Type Unspecified
CA152225(MHS)Medicare UPIN
CA151140Medicaid
CA4213830Medicare UPIN