Provider Demographics
NPI:1801946033
Name:BLAU, CATHEY G (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CATHEY
Middle Name:G
Last Name:BLAU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CATHEY
Other - Middle Name:ANNE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:87079 AMBOY ROAD
Mailing Address - Street 2:
Mailing Address - City:29 PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277
Mailing Address - Country:US
Mailing Address - Phone:760-367-2117
Mailing Address - Fax:760-367-2117
Practice Address - Street 1:6528A HILLSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:29 PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277
Practice Address - Country:US
Practice Address - Phone:760-367-2117
Practice Address - Fax:760-367-2117
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS67021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13729ZMedicare UPIN