Healthcare Provider Details

I. General information

NPI: 1003779059
Provider Name (Legal Business Name): KATRINA RENEE DORSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 W OCEAN BLVD STE 800
LONG BEACH CA
90802-4529
US

IV. Provider business mailing address

19124 RADLETT AVE
CARSON CA
90746-2682
US

V. Phone/Fax

Practice location:
  • Phone: 562-682-1047
  • Fax:
Mailing address:
  • Phone: 323-552-4814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW131694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: