Provider Demographics
NPI:1669672077
Name:MCGILL, KATHLEEN L (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:MCGILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANAYA
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2344 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2412
Mailing Address - Country:US
Mailing Address - Phone:510-684-6940
Mailing Address - Fax:
Practice Address - Street 1:9925 INTERNATIONAL BLVD STE 6
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94603-2558
Practice Address - Country:US
Practice Address - Phone:510-562-3731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical