Provider Demographics
NPI:1922291608
Name:GLASER, KATHY JO (MFT #18869)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:JO
Last Name:GLASER
Suffix:
Gender:F
Credentials:MFT #18869
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12960 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1307
Mailing Address - Country:US
Mailing Address - Phone:510-215-2280
Mailing Address - Fax:
Practice Address - Street 1:12960 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-1307
Practice Address - Country:US
Practice Address - Phone:510-215-2280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18869106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist