Provider Demographics
NPI:1679792956
Name:EGAN, KATHY GARCIA (MSW)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:GARCIA
Last Name:EGAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10159
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91209-3159
Mailing Address - Country:US
Mailing Address - Phone:818-240-5434
Mailing Address - Fax:
Practice Address - Street 1:1530 E CHEVY CHASE DR STE 203
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4139
Practice Address - Country:US
Practice Address - Phone:818-240-5434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 13585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health