Provider Demographics
NPI:1366019911
Name:PARKER, KEVIN E (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:E
Last Name:PARKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1110
Mailing Address - Country:US
Mailing Address - Phone:818-409-3020
Mailing Address - Fax:
Practice Address - Street 1:141 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1207
Practice Address - Country:US
Practice Address - Phone:818-839-4010
Practice Address - Fax:818-839-4011
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW256121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical