Provider Demographics
NPI:1497855258
Name:BARTHOLOMEW, KARLOTTA L (PHD)
Entity Type:Individual
Prefix:
First Name:KARLOTTA
Middle Name:L
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 CROW CANYON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1639
Mailing Address - Country:US
Mailing Address - Phone:925-831-0341
Mailing Address - Fax:925-855-9075
Practice Address - Street 1:2817 CROW CANYON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1639
Practice Address - Country:US
Practice Address - Phone:925-831-0341
Practice Address - Fax:925-855-9075
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 10548103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94 3073338OtherFEDERAL TAX ID
CAPSY 10548OtherPSYCHOLOGY LICENSE NUMBER
CAPSY 10548OtherPSYCHOLOGY LICENSE NUMBER