Provider Demographics
NPI:1710930417
Name:SEVERIN, KATHRINE SUZANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRINE
Middle Name:SUZANNE
Last Name:SEVERIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KATHRINE
Other - Middle Name:SUZANNE
Other - Last Name:SHILSTONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:158 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2810
Mailing Address - Country:US
Mailing Address - Phone:650-493-5000
Mailing Address - Fax:650-617-2787
Practice Address - Street 1:795 WILLOW RD
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2539
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-617-2787
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA229701041C0700X
NY069647-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical