Basic Information
| Provider Information | |||||||||
| NPI: | 1306943642 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CREMA | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | CHIESA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 HWY 89 NORTH | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863135001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284454861 | ||||||||
| FaxNumber: | 9287766125 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 HWY 89 NORTH | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863135001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284454861 | ||||||||
| FaxNumber: | 9287766125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 3448 | AZ | X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103TC0700X | 3448 | AZ | X | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TH0100X | 3448 | AZ | X | Behavioral Health & Social Service Providers | Psychologist | Health Service |
No ID Information.