Healthcare Provider Details

I. General information

NPI: 1124498043
Provider Name (Legal Business Name): KATHERINE WINSHIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 MORENA BLVD STE 2
SAN DIEGO CA
92110-3889
US

IV. Provider business mailing address

3050 RUE DORLEANS UNIT 303
SAN DIEGO CA
92110-5929
US

V. Phone/Fax

Practice location:
  • Phone: 619-398-3261
  • Fax: 619-275-2023
Mailing address:
  • Phone: 415-378-8360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number69759
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW69759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: