Provider Demographics
NPI:1922334515
Name:MANN, KATIE B (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:B
Last Name:MANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N. EL CAMINO REAL
Mailing Address - Street 2:#100
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672
Mailing Address - Country:US
Mailing Address - Phone:949-218-8227
Mailing Address - Fax:
Practice Address - Street 1:1401 N. EL CAMINO REAL
Practice Address - Street 2:#100
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672
Practice Address - Country:US
Practice Address - Phone:949-218-8227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS169621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical