Basic Information
Provider Information
NPI: 1205826047
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DURNING
FirstName: KATHLEEN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2231 CAMINO DEL RIO S
Address2: STE 308
City: SAN DIEGO
State: CA
PostalCode: 921083612
CountryCode: US
TelephoneNumber: 6192815521
FaxNumber: 6192603054
Practice Location
Address1: 2231 CAMINO DEL RIO S
Address2: STE 308
City: SAN DIEGO
State: CA
PostalCode: 921083612
CountryCode: US
TelephoneNumber: 6192815521
FaxNumber: 6192603054
Other Information
ProviderEnumerationDate: 10/24/2005
LastUpdateDate: 08/17/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700XPSY5842CAY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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