Provider Demographics
NPI:1538569520
Name:QUEIROZ, KATHERINE BONETE (LCSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BONETE
Last Name:QUEIROZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANICETO
Other - Last Name:BONETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 N. GLENOAKS BLVD.
Mailing Address - Street 2:SUITE #200
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502
Mailing Address - Country:US
Mailing Address - Phone:818-738-7315
Mailing Address - Fax:310-945-3356
Practice Address - Street 1:303 N. GLENOAKS BLVD.
Practice Address - Street 2:SUITE #200
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502
Practice Address - Country:US
Practice Address - Phone:818-738-7315
Practice Address - Fax:310-945-3356
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1102741041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program