Provider Demographics
NPI:1952576746
Name:INTRAVIA, CATHERINE M (SUDCC III-CS #6319)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:M
Last Name:INTRAVIA
Suffix:
Gender:F
Credentials:SUDCC III-CS #6319
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:M
Other - Last Name:INTRAVIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SUDCC III-CS #6319
Mailing Address - Street 1:16433 MONTEREY RD
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-7168
Mailing Address - Country:US
Mailing Address - Phone:408-782-6300
Mailing Address - Fax:408-782-6363
Practice Address - Street 1:16433 MONTEREY RD
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-7168
Practice Address - Country:US
Practice Address - Phone:408-782-6300
Practice Address - Fax:408-782-6363
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6319101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU6021791OtherCALIFORNIA DRIVERS LICENSE