Provider Demographics
NPI:1558403527
Name:MAXWELL, KATHRYN M (PHD)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:M
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4462
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95402-4462
Mailing Address - Country:US
Mailing Address - Phone:707-237-8900
Mailing Address - Fax:707-237-8900
Practice Address - Street 1:1002 SPENCER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3816
Practice Address - Country:US
Practice Address - Phone:707-237-8900
Practice Address - Fax:707-237-8900
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44114106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist