Healthcare Provider Details

I. General information

NPI: 1205758091
Provider Name (Legal Business Name): KATE LIEDL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 STEVENSON ST
SAN FRANCISCO CA
94103-1606
US

IV. Provider business mailing address

619 HAIGHT ST
SAN FRANCISCO CA
94117-3304
US

V. Phone/Fax

Practice location:
  • Phone: 415-919-2907
  • Fax:
Mailing address:
  • Phone: 415-572-9620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: