Provider Demographics
NPI:1558620419
Name:WONACOTT, KATHLEEN (MSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:WONACOTT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 SHATTUCK AVE UNIT 3593
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-7022
Mailing Address - Country:US
Mailing Address - Phone:415-457-3755
Mailing Address - Fax:415-457-0849
Practice Address - Street 1:5297 COLLEGE AVE
Practice Address - Street 2:STE 103
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618
Practice Address - Country:US
Practice Address - Phone:415-457-3755
Practice Address - Fax:415-457-0849
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77334101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health