MEDICARE: DR. KATHLEEN LORELLE STRAUSS PH D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY15765	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154362184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN LORELLE STRAUSS PH D

Provider Business Mailing Address
First Line	:	3914 3RD AVENUE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3095
Country	:	US
Telephone Number	:	619-291-4808
Fax Number	:	619-291-4426

Provider Business Practice Location Address
First Line	:	3914 3RD AVENUE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3095
Country	:	US
Telephone Number	:	619-291-4808
Fax Number	:	619-291-4426

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/09/2007

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