1720169279 NPI number — CATHERINE WILLKIE PSY

Table of content: CATHERINE WILLKIE PSY (NPI 1720169279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720169279 NPI number — CATHERINE WILLKIE PSY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLKIE
Provider First Name:
CATHERINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720169279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 962
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA CRUZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95061-0962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-454-4170
Provider Business Mailing Address Fax Number:
831-454-4663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 EMELINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CRUZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95060-1976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-454-4170
Provider Business Practice Location Address Fax Number:
831-454-4663
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 20380 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ92076Z . This is a "MEDICARE GROUP ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PSY 20380 . This is a "PSYCHOLOGIST #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ91892Z . This is a "MEDICARE GROUP ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ92073Z . This is a "MEDICARE GROUP ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ91891Z . This is a "MEDICARE GROUP ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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