Doctor Name: | KENNETH J DEAVER |
NPI Number: | 1053460733 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | LCS16585 |
Business Practice Address: | 15951 Los Gatos Blvd Ste 18 Los Gatos, CA - 950323488 |
Business Phone Number: | 4083589596 |
Business Fax Number: | 4083589596 |
Mailing Address: | 15951 Los Gatos Blvd Ste 18, LOS GATOS |
State: | CA |
Postal Code: | 950323488 |
Phone Number: | 4083589596 |
Fax Number: | 4083589596 |
NPI Enumeration Date: | 01/10/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LCS16585 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |