Provider Demographics
NPI:1124282801
Name:WOODMANSEE, KATYA (PHD)
Entity type:Individual
Prefix:DR
First Name:KATYA
Middle Name:
Last Name:WOODMANSEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 SHATTUCK AVE # 104
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1986
Mailing Address - Country:US
Mailing Address - Phone:510-595-4670
Mailing Address - Fax:
Practice Address - Street 1:2931 SHATTUCK AVE # 104
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1986
Practice Address - Country:US
Practice Address - Phone:510-595-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21696103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent