Provider Demographics
NPI:1487133195
Name:DAVIS, KATHRYN MAE (LCSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 SEPULVEDA BLVD UNIT 210
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3934
Mailing Address - Country:US
Mailing Address - Phone:424-218-9880
Mailing Address - Fax:
Practice Address - Street 1:4401 SEPULVEDA BLVD UNIT 210
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3934
Practice Address - Country:US
Practice Address - Phone:424-218-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW101545101YM0800X
CALCSW110970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health