Provider Demographics
NPI:1609170760
Name:KAGAN, COLORADO MARIA (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:COLORADO
Middle Name:MARIA
Last Name:KAGAN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 COLLEGE AVE
Mailing Address - Street 2:SUITE 314E
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1583
Mailing Address - Country:US
Mailing Address - Phone:510-297-4937
Mailing Address - Fax:
Practice Address - Street 1:5655 COLLEGE AVE
Practice Address - Street 2:SUITE 314E
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1583
Practice Address - Country:US
Practice Address - Phone:510-297-4937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36385101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health