=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952425472
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVAN PETER KATTEN LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 08/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 S EUCLID AVE STE 7
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-2472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-795-9065
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3941 SANTA CARLOTTA ST
-----------------------------------------------------
City | LA CRESCENTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91214-1053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-541-5500
-----------------------------------------------------
Fax | 818-541-5500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCS12330
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------