Provider Demographics
NPI:1255325387
Name:PESAVENTO, KAYE (LCSW,BCD)
Entity Type:Individual
Prefix:MS
First Name:KAYE
Middle Name:
Last Name:PESAVENTO
Suffix:
Gender:F
Credentials:LCSW,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 RUE AVALLON
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1212
Mailing Address - Country:US
Mailing Address - Phone:619-227-5079
Mailing Address - Fax:619-656-0835
Practice Address - Street 1:180 OTAY LAKES RD
Practice Address - Street 2:SUITE 107
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-2443
Practice Address - Country:US
Practice Address - Phone:619-227-5079
Practice Address - Fax:619-656-0835
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 56941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical