Provider Demographics
NPI:1154362184
Name:STRAUSS, KATHLEEN LORELLE (PH D)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LORELLE
Last Name:STRAUSS
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 3RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3095
Mailing Address - Country:US
Mailing Address - Phone:619-291-4808
Mailing Address - Fax:619-291-4426
Practice Address - Street 1:3914 3RD AVENUE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3095
Practice Address - Country:US
Practice Address - Phone:619-291-4808
Practice Address - Fax:619-291-4426
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15765103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY157650Medicaid
CAPSY157650Medicaid
S57343Medicare UPIN