Healthcare Provider Details

I. General information

NPI: 1972778587
Provider Name (Legal Business Name): MS. KATHRINE HAALAND LUNDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRINE HAALAND LUNDY LCSW

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OCEANGATE STE 550
LONG BEACH CA
90802-4312
US

IV. Provider business mailing address

150 W 7TH ST
SAN PEDRO CA
90731-3320
US

V. Phone/Fax

Practice location:
  • Phone: 562-435-3037
  • Fax: 562-256-1603
Mailing address:
  • Phone: 310-519-6100
  • Fax: 310-732-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: