Provider Demographics
NPI:1972657419
Name:COUTRAKON, KATHERINE BARRON (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:BARRON
Last Name:COUTRAKON
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KATHERINE B COUTRAKON
Mailing Address - Street 2:1748 CHAPPARAL DR
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373
Mailing Address - Country:US
Mailing Address - Phone:909-730-4106
Mailing Address - Fax:
Practice Address - Street 1:KATHERINE B COUTRAKON
Practice Address - Street 2:1748 CHAPPARAL DR
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:909-730-4106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA194761041C0700X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical