Provider Demographics
NPI:1417132275
Name:PARKER, KENNETH JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:PARKER
Suffix:JR
Gender:M
Credentials:PHD
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 6831
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95150-6831
Mailing Address - Country:US
Mailing Address - Phone:408-612-4935
Mailing Address - Fax:
Practice Address - Street 1:441 PARK AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-2615
Practice Address - Country:US
Practice Address - Phone:408-287-2640
Practice Address - Fax:408-287-7428
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9141103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist