Provider Demographics
NPI:1962748061
Name:KIFER, KATHY MARIE SCALISE (MFT)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:MARIE SCALISE
Last Name:KIFER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 JEFFERSON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5561
Mailing Address - Country:US
Mailing Address - Phone:707-428-7100
Mailing Address - Fax:
Practice Address - Street 1:711 JEFFERSON ST STE 101
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5561
Practice Address - Country:US
Practice Address - Phone:707-428-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52734103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst