Provider Demographics
NPI:1487137113
Name:SUTTON, KATHERINE (PHD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 ADRAGNA CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-2301
Mailing Address - Country:US
Mailing Address - Phone:408-444-5283
Mailing Address - Fax:
Practice Address - Street 1:825 SAN ANTONIO RD STE 104
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-4620
Practice Address - Country:US
Practice Address - Phone:650-272-0388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26739103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist