Provider Demographics
NPI:1144182965
Name:AGAJANIAN, KATELYN ESTHER
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ESTHER
Last Name:AGAJANIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:CUTTEN
Mailing Address - State:CA
Mailing Address - Zip Code:95534-0105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 105
Practice Address - Street 2:
Practice Address - City:CUTTEN
Practice Address - State:CA
Practice Address - Zip Code:95534-0105
Practice Address - Country:US
Practice Address - Phone:707-502-2435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1293521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical