Healthcare Provider Details

I. General information

NPI: 1558878066
Provider Name (Legal Business Name): CARA OLNEY-KENISTON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 N 1ST ST
SAN JOSE CA
95113-1006
US

IV. Provider business mailing address

1387 SANTA FE DR
SAN JOSE CA
95118-2439
US

V. Phone/Fax

Practice location:
  • Phone: 408-534-5753
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT47421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: