Provider Demographics
NPI:1922174572
Name:KOSTOULAS, KATINA K (PHD)
Entity Type:Individual
Prefix:MS
First Name:KATINA
Middle Name:K
Last Name:KOSTOULAS
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 1:3245 ANZA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3025
Mailing Address - Country:US
Mailing Address - Phone:415-463-5119
Mailing Address - Fax:415-340-3261
Practice Address - Street 1:3245 ANZA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-3025
Practice Address - Country:US
Practice Address - Phone:415-463-5119
Practice Address - Fax:415-340-3261
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10938103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist