Provider Demographics
NPI:1376768481
Name:BESSIERES, KYLEANNE MARIE MABEY (LCSW)
Entity Type:Individual
Prefix:
First Name:KYLEANNE
Middle Name:MARIE MABEY
Last Name:BESSIERES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KYLEANNE
Other - Middle Name:MARIE
Other - Last Name:MABEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2275 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1132
Mailing Address - Country:US
Mailing Address - Phone:510-301-4508
Mailing Address - Fax:
Practice Address - Street 1:42875 GATEWOOD ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4131
Practice Address - Country:US
Practice Address - Phone:510-301-4508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical