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General NPI Number Information
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NPI Number | 1558620419
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Entity Type | Individual
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Provider Name | KATHLEEN WONACOTT MSW
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Gender | Female
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 5297 COLLEGE AVE STE 103
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City | OAKLAND
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State | CA
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Zip | 94618
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Country | US
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Telephone | 415-457-3755
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Fax | 415-457-0849
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Provider Business Mailing Address
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Address Line | 4900 SHATTUCK AVE UNIT 3593
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City | OAKLAND
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State | CA
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Zip | 94609-7022
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Country | US
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Telephone | 415-457-3755
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Fax | 415-457-0849
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 77334
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License Number State | CA
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