Provider Demographics
NPI:1053950634
Name:KAWAMURA, KATHLEEN (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:KAWAMURA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604-B EL CAMINO REAL
Mailing Address - Street 2:#405
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1205
Mailing Address - Country:US
Mailing Address - Phone:760-295-3988
Mailing Address - Fax:
Practice Address - Street 1:2604-B EL CAMINO REAL
Practice Address - Street 2:#405
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1205
Practice Address - Country:US
Practice Address - Phone:760-295-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19507103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical