Provider Demographics
NPI:1588856017
Name:ROZAKIS, KATERINA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATERINA
Middle Name:
Last Name:ROZAKIS
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 1:416 SUMMERCREEK LN
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4464
Mailing Address - Country:US
Mailing Address - Phone:925-216-3510
Mailing Address - Fax:925-560-0633
Practice Address - Street 1:2821 CROW CANYON RD
Practice Address - Street 2:STE 202
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1659
Practice Address - Country:US
Practice Address - Phone:925-216-3510
Practice Address - Fax:925-553-7881
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA189531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW189530 / 4004732OtherMEDICAL
CAZZZ15994ZMedicare UPIN