Healthcare Provider Details

I. General information

NPI: 1083052179
Provider Name (Legal Business Name): KATHRYN RABAK ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 I ST UNIT 203
SACRAMENTO CA
95816-4421
US

IV. Provider business mailing address

3101 I ST UNIT 203
SACRAMENTO CA
95816-4421
US

V. Phone/Fax

Practice location:
  • Phone: 916-836-4099
  • Fax:
Mailing address:
  • Phone: 916-836-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW77746
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW101927
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: