Provider Demographics
NPI:1467920108
Name:KASIH, GEORGINA
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:KASIH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17035 SAN BERNARDINO AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6743
Mailing Address - Country:US
Mailing Address - Phone:559-901-6422
Mailing Address - Fax:559-901-6422
Practice Address - Street 1:17035 SAN BERNARDINO AVE APT 14
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6743
Practice Address - Country:US
Practice Address - Phone:559-901-6422
Practice Address - Fax:559-901-6422
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW83618101YM0800X
CA1142911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health