Provider Demographics
NPI:1639248826
Name:PARKER, CATHY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 TRANCAS ST # 354
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2912
Mailing Address - Country:US
Mailing Address - Phone:707-363-2698
Mailing Address - Fax:707-259-0827
Practice Address - Street 1:45445 PORTOLA AVE
Practice Address - Street 2:STE 2B
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4844
Practice Address - Country:US
Practice Address - Phone:707-363-2698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21556103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11264Medicaid
CAPSY21556OtherBOARD OF PSYCHOLOGY
CA11264Medicaid