Healthcare Provider Details

I. General information

NPI: 1669438768
Provider Name (Legal Business Name): KATHLEEN ANN HARE RN,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 WILLOW VALLEY RD
NEVADA CITY CA
95959-9451
US

IV. Provider business mailing address

10700 WILLOW VALLEY RD
NEVADA CITY CA
95959-9451
US

V. Phone/Fax

Practice location:
  • Phone: 530-265-5758
  • Fax: 530-265-5758
Mailing address:
  • Phone: 530-265-5758
  • Fax: 530-265-5758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS12675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: