Provider Demographics
NPI:1821128729
Name:DILLAVOU, CATHERINE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:DILLAVOU
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 1:699 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3817
Mailing Address - Country:US
Mailing Address - Phone:323-221-4134
Mailing Address - Fax:323-226-4588
Practice Address - Street 1:1721 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-3062
Practice Address - Country:US
Practice Address - Phone:323-221-4134
Practice Address - Fax:323-226-4588
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW11142101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health