Katherine L Decosta, LCSW
Individual provider Active NPI Clinical Social Worker · Patton, CA
NPI 1972052991 · NPPES record last updated Oct 3, 2016
Key facts
- NPI
- 1972052991
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 22283 (CA)
- Practice address
- 3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369 - Phone
- (909) 425-7000
- NPI assigned
- Oct 3, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22283 | CA | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 22283 | CA | Yes |
Addresses
Primary practice location
3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369
Mailing address
3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369
Phone (909) 425-7000
Other names
- Katherine L Mattox
Other providers in Patton, CA
- Michael Allen Cummings
- Brian Stewart Cunningham
- Sheri R Curtis
- Jason Darling
- May Allarde De San Jose
- Department of State Hospitals
- Manuel B Desagun
- Michael Dale Dewit
- Inderpal Dhillon
- Eddie Lee Diaz
All providers in Patton, CA · Clinical Social Worker in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.