Provider Demographics
NPI:1316973316
Name:HATCH, KATHERINE A (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:A
Last Name:HATCH
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 1:2955 SHATTUCK AVE
Mailing Address - Street 2:#7
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1808
Mailing Address - Country:US
Mailing Address - Phone:510-649-8929
Mailing Address - Fax:510-845-3382
Practice Address - Street 1:2955 SHATTUCK AVE
Practice Address - Street 2:#7
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705
Practice Address - Country:US
Practice Address - Phone:510-649-8929
Practice Address - Fax:844-584-4208
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9783103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01474304Medicaid
CAPSY097830Medicaid
CACD527AMedicare PIN
CA00PL97830Medicare ID - Type Unspecified