Provider Demographics
NPI:1770128431
Name:SARACENO, KATHERINE ROSE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ROSE
Last Name:SARACENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ROSE
Other - Last Name:FIGUEROA SARACENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:160 J ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-8001
Mailing Address - Country:US
Mailing Address - Phone:424-789-0949
Mailing Address - Fax:
Practice Address - Street 1:160 J ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-8001
Practice Address - Country:US
Practice Address - Phone:424-789-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-16
Last Update Date:2024-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138479106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAUNKNOWNMedicaid