MEDICARE: KATHERINE ANNE STOCKLY

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	1041C0700X	Clinical Social Worker	LCSW127524	CA

General Provider Information

NPI Number	:	1609357698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ANNE STOCKLY

Provider Business Mailing Address
First Line	:	3154 GLENDALE BLVD # 1082
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1830
Country	:	US
Telephone Number	:	818-641-5344
Fax Number	:

Provider Business Practice Location Address
First Line	:	3154 GLENDALE BLVD # 1082
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1830
Country	:	US
Telephone Number	:	818-641-5344
Fax Number	:

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

Provider Enumeration Date	:	08/27/2018
Last Update Date	:	07/03/2025

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