Healthcare Provider Details

I. General information

NPI: 1437746732
Provider Name (Legal Business Name): DENISE KEE-WHITE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 TELEGRAPH AVE STE 204
BERKELEY CA
94705-1150
US

IV. Provider business mailing address

6716 S GARTH AVE
LOS ANGELES CA
90056-2206
US

V. Phone/Fax

Practice location:
  • Phone: 888-588-8995
  • Fax:
Mailing address:
  • Phone: 310-210-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW25537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: