Provider Demographics
NPI:1659549491
Name:POLLOCK, KATHERINE (MA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KATER
Other - Middle Name:
Other - Last Name:POLLOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1515 CAPITOLA RD
Mailing Address - Street 2:SUITE O
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2954
Mailing Address - Country:US
Mailing Address - Phone:831-462-1407
Mailing Address - Fax:
Practice Address - Street 1:1515 CAPITOLA RD
Practice Address - Street 2:SUITE O
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2954
Practice Address - Country:US
Practice Address - Phone:831-462-1407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT18526106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist