Provider Demographics
NPI:1336655638
Name:LOVE, KENNETTE
Entity Type:Individual
Prefix:
First Name:KENNETTE
Middle Name:
Last Name:LOVE
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 1:9015 MURRAY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3617
Mailing Address - Country:US
Mailing Address - Phone:408-784-0913
Mailing Address - Fax:
Practice Address - Street 1:9015 MURRAY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3617
Practice Address - Country:US
Practice Address - Phone:408-784-0913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health