Provider Demographics
NPI:1457683872
Name:BLANK, KATHERINE JENNIFER (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JENNIFER
Last Name:BLANK
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 1:1530 MCALLISTER ST
Mailing Address - Street 2:#1
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-4456
Mailing Address - Country:US
Mailing Address - Phone:602-881-0303
Mailing Address - Fax:
Practice Address - Street 1:2150 POST ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3508
Practice Address - Country:US
Practice Address - Phone:415-449-3753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW654461041C0700X
MALICSW1172761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical