Healthcare Provider Details

I. General information

NPI: 1326195751
Provider Name (Legal Business Name): DR. KATHLEEN (CATHERINE) PATRICIA SEYMOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 HAYES LN
PETALUMA CA
94952-4011
US

IV. Provider business mailing address

8653 LA SENDA CT
ALTA LOMA CA
91701-1374
US

V. Phone/Fax

Practice location:
  • Phone: 800-257-8715
  • Fax:
Mailing address:
  • Phone: 909-980-4137
  • Fax: 909-980-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY13043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: