Provider Demographics
NPI:1083198162
Name:KERMOTT, KYLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:KERMOTT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18010 SKY PARK CIR STE 290
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6487
Mailing Address - Country:US
Mailing Address - Phone:949-500-9109
Mailing Address - Fax:
Practice Address - Street 1:18010 SKY PARK CIR STE 290
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6487
Practice Address - Country:US
Practice Address - Phone:949-500-9109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30363103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical