Provider Demographics
NPI:1508223413
Name:GOWAN, KATHRYN FISHMAN (LCSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:FISHMAN
Last Name:GOWAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:GABRIELLE
Other - Last Name:FISHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW
Mailing Address - Street 1:2358 UNIVERSITY AVE # 2099
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2720
Mailing Address - Country:US
Mailing Address - Phone:781-956-1177
Mailing Address - Fax:
Practice Address - Street 1:2358 UNIVERSITY AVE # 2099
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2720
Practice Address - Country:US
Practice Address - Phone:781-956-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA849421041C0700X
CA686211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical