Provider Demographics
NPI:1871011239
Name:PROSSR, KATERINA PAIGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATERINA
Middle Name:PAIGE
Last Name:PROSSR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 MISSION AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-1327
Mailing Address - Country:US
Mailing Address - Phone:760-492-5656
Mailing Address - Fax:760-826-4900
Practice Address - Street 1:3355 MISSION AVE STE 111
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1327
Practice Address - Country:US
Practice Address - Phone:760-492-5656
Practice Address - Fax:760-826-4900
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAPSY30544103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1467978817Medicaid