Provider Demographics
NPI:1770888430
Name:ADAMOVIC, KATHLEEN CLEARY (MFT)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:CLEARY
Last Name:ADAMOVIC
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:KITTY
Other - Middle Name:CLEARY
Other - Last Name:ADAMOVIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:500 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5993
Mailing Address - Country:US
Mailing Address - Phone:424-254-9876
Mailing Address - Fax:
Practice Address - Street 1:500 PACIFIC COAST HIGHWAY
Practice Address - Street 2:SUITE 214
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740
Practice Address - Country:US
Practice Address - Phone:424-254-9876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53576106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist