Provider Demographics
NPI:1700628914
Name:VAN VLIET, KATE CORRINE (ACSW, RAD-T)
Entity type:Individual
Prefix:
First Name:KATE CORRINE
Middle Name:
Last Name:VAN VLIET
Suffix:
Gender:F
Credentials:ACSW, RAD-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11465 MOORPARK ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2032
Mailing Address - Country:US
Mailing Address - Phone:314-323-8229
Mailing Address - Fax:
Practice Address - Street 1:7864 WILLOUGHBY AVE
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-7225
Practice Address - Country:US
Practice Address - Phone:314-323-8229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1215011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical