Healthcare Provider Details

I. General information

NPI: 1366618217
Provider Name (Legal Business Name): KATHLEEN ROSE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHY ROSE LMFT

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 KEYSTONE PACIFIC PKWY
PATTERSON CA
95363-8872
US

IV. Provider business mailing address

712 H ST NE STE 47
WASHINGTON DC
20002-3627
US

V. Phone/Fax

Practice location:
  • Phone: 301-664-4601
  • Fax:
Mailing address:
  • Phone: 301-664-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC43841
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number43841
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: