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General NPI Number Information
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NPI Number | 1922146497
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Entity Type | Individual
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Provider Name | KENNETH HOWARD GERMANOW PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 620 CALIFORNIA BLVD SUITE P
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2541
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Country | US
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Telephone | 805-596-5146
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Fax |
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Provider Business Mailing Address
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Address Line | 356 MANZANITA DR
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City | LOS OSOS
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State | CA
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Zip | 93402-3616
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Country | US
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Telephone | 805-596-5146
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY10096
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License Number State | CA
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