MEDICARE: CORINNE KAVENY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	363A00000X	Physician Assistant		CA

General Provider Information

NPI Number	:	1063518538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORINNE KAVENY

Provider Business Mailing Address
First Line	:	1936 E ANAHEIM ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3908
Country	:	US
Telephone Number	:	562-599-2248
Fax Number	:

Provider Business Practice Location Address
First Line	:	1936 E ANAHEIM ST
Second Line	:	APT #207
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3908
Country	:	US
Telephone Number	:	970-227-2492
Fax Number	:	562-599-2248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	08/13/2013

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Directions to “ CORINNE KAVENY ” Practice Location

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