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General NPI Number Information
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NPI Number | 1225258387
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Entity Type | Individual
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Provider Name | KATHERINE MARIE FONTANA PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 152 SOUTH LASKY 203
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City | BEVERLY HILLS
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State | CA
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Zip | 90212
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Country | US
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Telephone | 310-271-2201
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 FOOTHILL ROAD
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City | OJAI
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State | CA
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Zip | 93023
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Country | US
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Telephone | 310-271-2201
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY8172
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License Number State | CA
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