Provider Demographics
NPI:1164822524
Name:KENNETH R. FINEMAN PH.D PSYCH CORP
Entity Type:Organization
Organization Name:KENNETH R. FINEMAN PH.D PSYCH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:FINEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-241-8560
Mailing Address - Street 1:11770 WARNER AVE STE 226
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2662
Mailing Address - Country:US
Mailing Address - Phone:714-241-8560
Mailing Address - Fax:
Practice Address - Street 1:11770 WARNER AVE STE 226
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2662
Practice Address - Country:US
Practice Address - Phone:714-241-8560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4064305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization