Provider Demographics
NPI:1154887859
Name:DE ARAKAL, KATHERYN ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:KATHERYN
Middle Name:ELIZABETH
Last Name:DE ARAKAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERYN
Other - Middle Name:ELIZABETH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 S MYRTLE AVE # 199
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3423
Mailing Address - Country:US
Mailing Address - Phone:626-415-7131
Mailing Address - Fax:
Practice Address - Street 1:595 E COLORADO BLVD STE 612
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2015
Practice Address - Country:US
Practice Address - Phone:626-415-7131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF98360103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling