Healthcare Provider Details

I. General information

NPI: 1952425472
Provider Name (Legal Business Name): EVAN PETER KATTEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S EUCLID AVE STE 7
PASADENA CA
91101-2472
US

IV. Provider business mailing address

3941 SANTA CARLOTTA ST
LA CRESCENTA CA
91214-1053
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-9065
  • Fax:
Mailing address:
  • Phone: 818-541-5500
  • Fax: 818-541-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS12330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: