1538569520 NPI number — KATHERINE BONETE QUEIROZ LCSW

Table of content: KATHERINE BONETE QUEIROZ LCSW (NPI 1538569520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538569520 NPI number — KATHERINE BONETE QUEIROZ LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUEIROZ
Provider First Name:
KATHERINE
Provider Middle Name:
BONETE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BONETE
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
ANICETO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538569520
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 N. GLENOAKS BLVD.
Provider Second Line Business Mailing Address:
SUITE #200
Provider Business Mailing Address City Name:
BURBANK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-738-7315
Provider Business Mailing Address Fax Number:
310-945-3356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 N. GLENOAKS BLVD.
Provider Second Line Business Practice Location Address:
SUITE #200
Provider Business Practice Location Address City Name:
BURBANK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-738-7315
Provider Business Practice Location Address Fax Number:
310-945-3356
Provider Enumeration Date:
08/27/2014

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: 1041C0700X , with the licence number:  110274 , 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)