Provider Demographics
NPI:1245089853
Name:SUMMERS, KATHY (LCSW)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 N BOURBON ST APT 80
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-2474
Mailing Address - Country:US
Mailing Address - Phone:714-606-5106
Mailing Address - Fax:
Practice Address - Street 1:2627 N BOURBON ST APT 80
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-2474
Practice Address - Country:US
Practice Address - Phone:714-606-5106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1107741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical