Provider Demographics
NPI:1457476764
Name:EMERICK, KATHERINE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:J
Last Name:EMERICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:EMERICK
Other - Last Name:REGESTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1280 S VICTORIA AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6555
Mailing Address - Country:US
Mailing Address - Phone:805-655-5021
Mailing Address - Fax:
Practice Address - Street 1:1280 S VICTORIA AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6555
Practice Address - Country:US
Practice Address - Phone:805-655-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7870103TA0400X, 103TB0200X, 103TC0700X, 103TE1100X, 103TF0000X, 103TF0200X, 103TH0100X, 103T00000X, 103TP2701X
CACA7870103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP7870Medicare PIN