Basic Information
| Provider Information | |||||||||
| NPI: | 1730365248 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIONISIO | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | FAN | ||||||||
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| Credential: | PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FAN | ||||||||
| OtherFirstName: | CATHERINE | ||||||||
| OtherMiddleName: | KAY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 710 S BROADWAY STE 300 | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945965229 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 710 S BROADWAY STE 300 | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945965229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252954145 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2008 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
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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 | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103TC0700X | PSY26492 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.