Provider Demographics
NPI:1568504504
Name:GERSTNER, KATHLEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:GERSTNER
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 1:908 W CHANDLER BLVD
Mailing Address - Street 2:STE C-8
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2539
Mailing Address - Country:US
Mailing Address - Phone:480-382-0810
Mailing Address - Fax:
Practice Address - Street 1:908 W CHANDLER BLVD
Practice Address - Street 2:STE C-8
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2539
Practice Address - Country:US
Practice Address - Phone:480-382-0810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-132201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical