Provider Demographics
NPI:1891056800
Name:KITLOWSKI, KATHLEEN (PHD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:KITLOWSKI
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 1:27268 VIA INDUSTRIA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3751
Mailing Address - Country:US
Mailing Address - Phone:951-252-4065
Mailing Address - Fax:
Practice Address - Street 1:27268 VIA INDUSTRIA
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3751
Practice Address - Country:US
Practice Address - Phone:951-252-4065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-6809103K00000X
CAPSY15662103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst