Provider Demographics
NPI:1114891041
Name:GARDELLA, KATHRYN TORRES
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:TORRES
Last Name:GARDELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PARKSHORE DR # 100
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4726
Mailing Address - Country:US
Mailing Address - Phone:916-459-8854
Mailing Address - Fax:916-404-5622
Practice Address - Street 1:101 PARKSHORE DR # 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4726
Practice Address - Country:US
Practice Address - Phone:916-459-8854
Practice Address - Fax:916-404-5622
Is Sole Proprietor?:No
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148141106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist