Provider Demographics
NPI:1316013543
Name:LEE, KENNETH ALVIN (MSW)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALVIN
Last Name:LEE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:KEN
Other - Middle Name:A
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:315 CORBETT AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1884
Mailing Address - Country:US
Mailing Address - Phone:415-861-3886
Mailing Address - Fax:
Practice Address - Street 1:315 CORBETT AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1884
Practice Address - Country:US
Practice Address - Phone:415-861-3886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS252261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316013543Medicare UPIN
CA1316013543Medicare NSC
CA1316013543Medicare PIN
CA1316013543Medicare Oscar/Certification