Provider Demographics
NPI:1972778587
Name:LUNDY, KATHRINE HAALAND
Entity Type:Individual
Prefix:MS
First Name:KATHRINE
Middle Name:HAALAND
Last Name:LUNDY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KATHRINE
Other - Middle Name:HAALAND
Other - Last Name:LUNDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:150 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3320
Mailing Address - Country:US
Mailing Address - Phone:310-519-6100
Mailing Address - Fax:310-732-5809
Practice Address - Street 1:100 OCEANGATE
Practice Address - Street 2:STE 550
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4312
Practice Address - Country:US
Practice Address - Phone:562-435-3037
Practice Address - Fax:562-256-1603
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical