Provider Demographics
NPI:1609912021
Name:CURTIS, CATHY JANE (LCS)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:JANE
Last Name:CURTIS
Suffix:
Gender:F
Credentials:LCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 TREVETHAN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1344
Mailing Address - Country:US
Mailing Address - Phone:831-458-4141
Mailing Address - Fax:
Practice Address - Street 1:501 CEDAR ST
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4358
Practice Address - Country:US
Practice Address - Phone:831-425-8181
Practice Address - Fax:831-425-8181
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 176431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27177ZMedicare ID - Type Unspecified