Provider Demographics
NPI:1710693189
Name:OLIVETTI, KATHERINE WATTIKER (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:WATTIKER
Last Name:OLIVETTI
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 1:27 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:ATHERTON
Mailing Address - State:CA
Mailing Address - Zip Code:94027-3120
Mailing Address - Country:US
Mailing Address - Phone:646-256-2455
Mailing Address - Fax:
Practice Address - Street 1:27 LAUREL ST
Practice Address - Street 2:
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027-3120
Practice Address - Country:US
Practice Address - Phone:646-256-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000794-01102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst