Katherine C Andre, PH.D.
Individual provider Active NPI Clinical Psychologist · Lakeport, CA
NPI 1255412870 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1255412870
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY 12257 (CA)
- Practice address
- 75 4TH St
Lakeport, CA 95453-4804 - Phone
- (707) 263-6360
- Fax
- (707) 263-6360
- NPI assigned
- Oct 18, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 12257 | CA | MD | Clinical Psychologist |
| 12257 | CA | MD | Acupuncturist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 12257 | CA | Yes |
Addresses
Primary practice location
75 4TH St
Lakeport, CA 95453-4804
Mailing address
PO Box 1192
Lakeport, CA 95453-1192
Phone (707) 263-6360
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY12257 | Other | CA | LICENSE NUMBER |
Other providers in Lakeport, CA
- Daniel Alekyan
- Alexander R. McGeoch, DDS, Apc
- Mohamad Moutaz Almawaldi
- Alpha Respiratory Inc.
- Loretta Ancellotti
- Irinna Andrianarijaona
- Kraivit Angsupanich
- Tizah Evelyn Anjeh
- Anytime Rides
- Apria Healthcare LLC
All providers in Lakeport, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.