Provider Demographics
NPI:1104059401
Name:GORIA, KATHRYN JEAN (MFC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JEAN
Last Name:GORIA
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 ATLANTIC AVE
Mailing Address - Street 2:SUITE 430
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2218
Mailing Address - Country:US
Mailing Address - Phone:562-428-3266
Mailing Address - Fax:562-428-3288
Practice Address - Street 1:4401 ATLANTIC AVE
Practice Address - Street 2:SUITE 430
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2218
Practice Address - Country:US
Practice Address - Phone:562-428-3266
Practice Address - Fax:562-428-3288
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44721106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist