MEDICARE: DR. KEVIN MICHAEL KILBANE PH. D., M.A., MFT

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	106H00000X	Marriage & Family Therapist	MFC36992	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A892652	OTHER	CA	VALUE OPTIONS
2	093481	OTHER	CA	HEALTHNET
3	235980191	OTHER	CA	UNITED BEHAVIORAL HEALTH
4	550010002625	OTHER	CA	PACIFIC CARE BEHAVIORAL
5	7633602	OTHER	CA	AETNA
6	10957501	OTHER	CA	BLUE CROSS

General Provider Information

NPI Number	:	1720097983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN MICHAEL KILBANE PH. D., M.A., MFT

Provider Business Mailing Address
First Line	:	3815 ATLANTIC AVE STE 2
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3500
Country	:	US
Telephone Number	:	562-424-8503
Fax Number	:	562-424-8772

Provider Business Practice Location Address
First Line	:	3815 ATLANTIC AVE STE 2
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3500
Country	:	US
Telephone Number	:	562-424-8503
Fax Number	:	562-424-8772

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	04/07/2010

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Directions to “ DR. KEVIN MICHAEL KILBANE PH. D., M.A., MFT” Practice Location

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