Provider Demographics
NPI:1043482201
Name:KANE, PETER L (RC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:L
Last Name:KANE
Suffix:
Gender:M
Credentials:RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16710 NE 79TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4466
Mailing Address - Country:US
Mailing Address - Phone:425-802-2050
Mailing Address - Fax:
Practice Address - Street 1:16710 NE 79TH ST STE 202
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4466
Practice Address - Country:US
Practice Address - Phone:425-802-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00017449101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor