Provider Demographics
NPI:1205970688
Name:ROGERS, KATHRYN SCHELLBACH (MFT)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:SCHELLBACH
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2235
Mailing Address - Country:US
Mailing Address - Phone:650-347-4951
Mailing Address - Fax:
Practice Address - Street 1:205 E 3RD AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4051
Practice Address - Country:US
Practice Address - Phone:650-348-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health