Healthcare Provider Details

I. General information

NPI: 1912554510
Provider Name (Legal Business Name): JEFFREY D. KAYE, LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18484 OUTER HWY 18 STE 125
APPLE VALLEY CA
92307-2371
US

IV. Provider business mailing address

19320 TEWA RD
APPLE VALLEY CA
92307-5158
US

V. Phone/Fax

Practice location:
  • Phone: 760-686-3768
  • Fax:
Mailing address:
  • Phone: 760-686-3768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY DOUGLAS KAYE
Title or Position: LCSW
Credential: MASTER OF SOCIAL WOR
Phone: 760-686-3768