Provider Demographics
NPI:1912190885
Name:ALTIERI, KATHLEEN D (LCSW, CACIII)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:D
Last Name:ALTIERI
Suffix:
Gender:F
Credentials:LCSW, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 LONE OAKS LOOP
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1469
Mailing Address - Country:US
Mailing Address - Phone:925-837-9253
Mailing Address - Fax:
Practice Address - Street 1:620 LONE OAKS LOOP
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1469
Practice Address - Country:US
Practice Address - Phone:925-837-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCACIII 6556101YA0400X
COLCSW7691041C0700X
ORL129791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)