Provider Demographics
NPI:1730791070
Name:WU, KATHERINE (PHD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:WU
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 1:130 S PATTERSON AVE UNIT 1186
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93116-7060
Mailing Address - Country:US
Mailing Address - Phone:949-861-0907
Mailing Address - Fax:
Practice Address - Street 1:10 ANZIO
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-7309
Practice Address - Country:US
Practice Address - Phone:949-861-0907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61286126103TC0700X
390200000X
CAPSY33602103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program