Provider Demographics
NPI:1871203216
Name:KATHRYN LIGE LICENSED CLINICAL SOCIAL WORKER INC.
Entity type:Organization
Organization Name:KATHRYN LIGE LICENSED CLINICAL SOCIAL WORKER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:650-395-8022
Mailing Address - Street 1:2310 HOMESTEAD RD.
Mailing Address - Street 2:STE. C1, #410
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024
Mailing Address - Country:US
Mailing Address - Phone:650-395-8022
Mailing Address - Fax:
Practice Address - Street 1:2310 HOMESTEAD RD STE C1410
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-7339
Practice Address - Country:US
Practice Address - Phone:650-395-8022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty