Provider Demographics
NPI:1962676361
Name:KASLE, DOUGLAS TAYLOR (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:TAYLOR
Last Name:KASLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:TAYLOR
Other - Last Name:ROTHSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:303 POTRERO ST
Mailing Address - Street 2:UNIT 307
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2741
Mailing Address - Country:US
Mailing Address - Phone:415-846-6401
Mailing Address - Fax:
Practice Address - Street 1:1848 MCALLISTER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-4321
Practice Address - Country:US
Practice Address - Phone:415-846-6401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20824103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical