Provider Demographics
NPI:1306031364
Name:CHOWDHARY, KAVITA KISHORE
Entity Type:Individual
Prefix:DR
First Name:KAVITA
Middle Name:KISHORE
Last Name:CHOWDHARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7001
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93423-7001
Mailing Address - Country:US
Mailing Address - Phone:805-468-2392
Mailing Address - Fax:805-468-3006
Practice Address - Street 1:10333 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5808
Practice Address - Country:US
Practice Address - Phone:805-468-2362
Practice Address - Fax:805-468-3006
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25367103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical