Provider Demographics
NPI:1053538173
Name:MCCLEARY, KATHERINE (MFT)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:MCCLEARY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 CHILVERTON ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1143
Mailing Address - Country:US
Mailing Address - Phone:831-421-0670
Mailing Address - Fax:
Practice Address - Street 1:104 S PARK WAY
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2202
Practice Address - Country:US
Practice Address - Phone:831-421-0670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23497106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist