Provider Demographics
NPI:1942650064
Name:VILA, KATHARINE L (PHD)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:L
Last Name:VILA
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 1:1801 BUSH ST STE 131C
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5273
Mailing Address - Country:US
Mailing Address - Phone:415-820-1414
Mailing Address - Fax:415-702-9023
Practice Address - Street 1:1801 BUSH ST STE 131C
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5273
Practice Address - Country:US
Practice Address - Phone:415-820-1414
Practice Address - Fax:415-702-9023
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22345101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health