Individual
DR. KATHLEEN M CONDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D
Contact information
Practice address
1080 EMELINE AVE, SANTA CRUZ, CA 95060-1966
(831) 454-4100
Mailing address
1080 EMELINE AVENUE, SANTA CRUZ, CA 95060-1976
(831) 454-4872
(831) 454-4296
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
24048
CA
103T00000X
Psychologist
PSY-202418
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659315430
NPI ORGANIZATION LEGAL ENTITY
CA
01
—
24048
PSYCHOLOGIST LICENSE NUMBER
CA
05
—
FHC70042F
—
CA
Enumeration date
02/20/2008
Last updated
08/29/2023
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