Healthcare Provider Details

I. General information

NPI: 1871203216
Provider Name (Legal Business Name): KATHRYN LIGE LICENSED CLINICAL SOCIAL WORKER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 09/08/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 HOMESTEAD RD STE C1410
LOS ALTOS CA
94024-7339
US

IV. Provider business mailing address

2310 HOMESTEAD RD. STE. C1, #410
LOS ALTOS CA
94024
US

V. Phone/Fax

Practice location:
  • Phone: 650-395-8022
  • Fax:
Mailing address:
  • Phone: 650-395-8022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN LIGE
Title or Position: PRESIDENT
Credential: LCSW
Phone: 650-395-8022