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NPI Code Detail

MEDICARE: KATHLEEN ANNE BOURNE PHD

MEDICARE: KATHLEEN ANNE BOURNE PHD
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
1106H00000XMarriage & Family TherapistMFT19927CA
2103TC0700XClinical PsychologistPSY14398CA

General Provider Information

NPI Number : 1770615072
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN ANNE BOURNE PHD
Provider Business Mailing Address
First Line : 3036 REGENT ST
Second Line :
City : BERKELEY
State : CA
Zip : 94705-2551
Country : US
Telephone Number : 510-295-7941
Fax Number :
Provider Business Practice Location Address
First Line : 3036 REGENT ST
Second Line :
City : BERKELEY
State : CA
Zip : 94705-2551
Country : US
Telephone Number : 510-295-7941
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2007
Last Update Date : 08/02/2016

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Directions to “ KATHLEEN ANNE BOURNE PHD” Practice Location

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