Provider Demographics
NPI:1003844572
Name:CHRISTENSEN, CATHLEEN M (MSW)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:M
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:M
Other - Last Name:COSTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:1635 DIVISADERO ST
Mailing Address - Street 2:STE 625, BOX 1821
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-476-4029
Mailing Address - Fax:415-476-4150
Practice Address - Street 1:401 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2211
Practice Address - Country:US
Practice Address - Phone:415-476-7000
Practice Address - Fax:415-502-2661
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP66372Medicare UPIN