Provider Demographics
NPI:1881227130
Name:MAZOLEWSKI, KATHLEEN (MFT, PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MAZOLEWSKI
Suffix:
Gender:F
Credentials:MFT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 CITRUS CIR STE 165
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2669
Mailing Address - Country:US
Mailing Address - Phone:925-400-7774
Mailing Address - Fax:
Practice Address - Street 1:3075 CITRUS CIR STE 165
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2669
Practice Address - Country:US
Practice Address - Phone:925-400-7774
Practice Address - Fax:925-553-5090
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19719225100000X
CA117110106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist