Provider Demographics
NPI:1730365248
Name:DIONISIO, CATHERINE FAN (PHD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:FAN
Last Name:DIONISIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:KAY
Other - Last Name:FAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:710 S BROADWAY STE 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:710 S BROADWAY STE 300
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5229
Practice Address - Country:US
Practice Address - Phone:925-295-4145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPSY26492103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program