Provider Demographics
NPI:1598331019
Name:ROSS, KATHRYN KASEY
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:KASEY
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 WILLOW PASS RD STE 203
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-7931
Mailing Address - Country:US
Mailing Address - Phone:925-825-1793
Mailing Address - Fax:
Practice Address - Street 1:555 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-3937
Practice Address - Country:US
Practice Address - Phone:925-432-4118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker