Healthcare Provider Details

I. General information

NPI: 1841677507
Provider Name (Legal Business Name): KENNETH KAFELE L.E.P., B.C.B.A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 W 49TH ST
LOS ANGELES CA
90037-2847
US

IV. Provider business mailing address

112 HARVARD AVE # 465
CLAREMONT CA
91711-4716
US

V. Phone/Fax

Practice location:
  • Phone: 909-538-2673
  • Fax:
Mailing address:
  • Phone: 909-576-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLEP3554
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: