Provider Demographics
NPI:1205107372
Name:SOMMERFELD, KATHERINE CHARJEAN (MA)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:CHARJEAN
Last Name:SOMMERFELD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:CHARJEAN
Other - Last Name:KYPRIOTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2130 STOCKTON BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1337
Mailing Address - Country:US
Mailing Address - Phone:760-987-8859
Mailing Address - Fax:
Practice Address - Street 1:2130 STOCKTON BLVD # 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1337
Practice Address - Country:US
Practice Address - Phone:760-987-8859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-22
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X, 172V00000X, 101Y00000X
CA175T00000X
CAYOEIPVLNUXFSDZGA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer Specialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor