| Doctor Name: | KENNETH RAVEN |
| NPI Number: | 1003955311 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | PSY6491 |
| Business Practice Address: | 25 W. Rolling Oaks Dr. Suite #107 Thousand Oaks, CA - 913611003 |
| Business Phone Number: | 8054977001 |
| Business Fax Number: | 8054988076 |
| Mailing Address: | 25 W. Rolling Oaks Dr., Suite #107 THOUSAND OAKS |
| State: | CA |
| Postal Code: | 913611003 |
| Phone Number: | 8054977001 |
| Fax Number: | 8054988076 |
| NPI Enumeration Date: | 02/05/2007 |
| NPI Last Update Date: | 08/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY6491 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |