Doctor Name: | MR. MARK KEVIN KALEMOS |
NPI Number: | 1184879405 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | LCS 24888 |
Business Practice Address: | 5905 Soquel Dr #300 Soquel, CA - 95073 |
Business Phone Number: | 8314623271 |
Business Fax Number: | 8314648048 |
Mailing Address: | 4300 Soquel Dr Spc 90, SOQUEL |
State: | CA |
Postal Code: | 950732140 |
Phone Number: | 8314623271 |
Fax Number: | 8314648048 |
NPI Enumeration Date: | 12/01/2008 |
NPI Last Update Date: | 12/01/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LCS 24888 |
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 |