Provider Demographics
NPI:1689867798
Name:CUTSHALL, KATHLEEN PURSEL (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:PURSEL
Last Name:CUTSHALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 SANTA CLARA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4443
Mailing Address - Country:US
Mailing Address - Phone:510-764-1292
Mailing Address - Fax:
Practice Address - Street 1:2245 SANTA CLARA AVE STE 200
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4443
Practice Address - Country:US
Practice Address - Phone:510-764-1292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 228191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical