Healthcare Provider Details

I. General information

NPI: 1710833579
Provider Name (Legal Business Name): STEVEN KENIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10981 HENDERSON RD
VENTURA CA
93004-2170
US

IV. Provider business mailing address

10981 HENDERSON RD
VENTURA CA
93004-2170
US

V. Phone/Fax

Practice location:
  • Phone: 805-330-1931
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: