Provider Demographics
NPI:1366776478
Name:PIEDMONTE, KATHLEEN MARY
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:PIEDMONTE
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 1:277 SOUTH ST
Mailing Address - Street 2:SUITE Y
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5039
Mailing Address - Country:US
Mailing Address - Phone:805-541-5144
Mailing Address - Fax:
Practice Address - Street 1:277 SOUTH ST
Practice Address - Street 2:SUITE Y
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5039
Practice Address - Country:US
Practice Address - Phone:805-541-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA02062009348953OtherCOUNSELOR