Provider Demographics
NPI:1215182878
Name:KENTON, NANCIE A (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:NANCIE
Middle Name:A
Last Name:KENTON
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5735 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95824-4528
Mailing Address - Country:US
Mailing Address - Phone:916-718-1633
Mailing Address - Fax:916-643-9193
Practice Address - Street 1:5735 47TH AVE.
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95824
Practice Address - Country:US
Practice Address - Phone:916-718-1633
Practice Address - Fax:916-939-2409
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15769103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical