Provider Demographics
NPI:1043362635
Name:TAYLOR, KATHERINE DIANE (LCSW MSW)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:DIANE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW MSW
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Mailing Address - Street 1:5855 E NAPLES PLAZA
Mailing Address - Street 2:#308
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5060
Mailing Address - Country:US
Mailing Address - Phone:562-433-2263
Mailing Address - Fax:562-594-4360
Practice Address - Street 1:5855 E NAPLES PLAZA
Practice Address - Street 2:#308
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5060
Practice Address - Country:US
Practice Address - Phone:562-433-2263
Practice Address - Fax:562-594-4360
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA79961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW7996Medicare ID - Type Unspecified