Provider Demographics
NPI:1588114219
Name:SOCHA, KATHRYN ANIELA (MA, BCBA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANIELA
Last Name:SOCHA
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:SOCHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3152 VISTA GRANDE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8888
Mailing Address - Country:US
Mailing Address - Phone:408-781-2715
Mailing Address - Fax:
Practice Address - Street 1:400 W VENTURA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-9142
Practice Address - Country:US
Practice Address - Phone:858-264-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA1-19-38983103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health