Provider Demographics
NPI:1679580799
Name:SARGEANT, KATHLEEN E (LCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:SARGEANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90009-0303
Mailing Address - Country:US
Mailing Address - Phone:800-854-5506
Mailing Address - Fax:800-854-8806
Practice Address - Street 1:90303 BOX
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90009-0303
Practice Address - Country:US
Practice Address - Phone:800-854-5506
Practice Address - Fax:800-854-8806
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS21967104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS21967OtherBOARD OF BEHAVIORAL SCIEN