Provider Demographics
NPI:1700863008
Name:REARDEN, KATHERINE SUSAN (LCSW, ACSW, BCD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:SUSAN
Last Name:REARDEN
Suffix:
Gender:F
Credentials:LCSW, ACSW, BCD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:PALEMRE
Other - Last Name:REARDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, ACSW, BCD
Mailing Address - Street 1:4060 N FERNHILL CIR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-2414
Mailing Address - Country:US
Mailing Address - Phone:520-298-8543
Mailing Address - Fax:520-228-5283
Practice Address - Street 1:5380 E KACHINA ST
Practice Address - Street 2:DAVIS-MONTHAN AFB
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85707-4923
Practice Address - Country:US
Practice Address - Phone:520-228-4926
Practice Address - Fax:520-228-5283
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA25931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical