Healthcare Provider Details

I. General information

NPI: 1578077111
Provider Name (Legal Business Name): KATHY ROSE MEZA LEON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY ROSE VALENCIA

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E COLORADO BLVD
PASADENA CA
91105-1938
US

IV. Provider business mailing address

10525 ARNWOOD RD
SYLMAR CA
91342-6802
US

V. Phone/Fax

Practice location:
  • Phone: 818-233-0817
  • Fax:
Mailing address:
  • Phone: 818-926-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107148
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: