Healthcare Provider Details

I. General information

NPI: 1568566016
Provider Name (Legal Business Name): KATHLEEN B. RAPP LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 ACADEMY DR
SOLANA BEACH CA
92075-2031
US

IV. Provider business mailing address

767 ACADEMY DR
SOLANA BEACH CA
92075-2031
US

V. Phone/Fax

Practice location:
  • Phone: 858-793-4580
  • Fax: 858-793-4406
Mailing address:
  • Phone: 858-793-4580
  • Fax: 858-793-4406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS12202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: