Provider Demographics
NPI:1467579979
Name:KRETZMER, KATHLEEN JO (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:JO
Last Name:KRETZMER
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 1:3954 FOREST HILL AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2416
Mailing Address - Country:US
Mailing Address - Phone:510-530-6922
Mailing Address - Fax:510-835-0164
Practice Address - Street 1:21847 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-6435
Practice Address - Country:US
Practice Address - Phone:510-851-5106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 113451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical