Provider Demographics
NPI:1013638550
Name:KATENDE, ERIC MICHAEL
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:MICHAEL
Last Name:KATENDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11661 TEXAS AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5675
Mailing Address - Country:US
Mailing Address - Phone:914-582-2619
Mailing Address - Fax:
Practice Address - Street 1:2233 CORINTH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1601
Practice Address - Country:US
Practice Address - Phone:914-582-2619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118935106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist