Provider Demographics
NPI:1063874014
Name:KATHLEEN RAPP, LICENSED CLINICAL SOCIAL WORKER A PC
Entity type:Organization
Organization Name:KATHLEEN RAPP, LICENSED CLINICAL SOCIAL WORKER A PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:858-793-4580
Mailing Address - Street 1:767 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2031
Mailing Address - Country:US
Mailing Address - Phone:858-793-4580
Mailing Address - Fax:858-793-4406
Practice Address - Street 1:767 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2031
Practice Address - Country:US
Practice Address - Phone:858-793-4580
Practice Address - Fax:858-793-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS12202101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0394839Medicare PIN