Provider Demographics
NPI:1881730513
Name:DENHAM, KATHRYN RENA (MSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RENA
Last Name:DENHAM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 ELIZABETH ST
Mailing Address - Street 2:STE 5
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4602
Mailing Address - Country:US
Mailing Address - Phone:707-447-4453
Mailing Address - Fax:707-447-1529
Practice Address - Street 1:419 ELIZABETH ST
Practice Address - Street 2:STE 5
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4602
Practice Address - Country:US
Practice Address - Phone:707-399-9540
Practice Address - Fax:707-447-1529
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 132851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical