Provider Demographics
NPI:1477891679
Name:BAVERY, KARINA ELENA (LMFT)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:ELENA
Last Name:BAVERY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KARINA
Other - Middle Name:ELENA
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 MCHENRY VILLAGE WAY STE 11
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4341
Mailing Address - Country:US
Mailing Address - Phone:209-526-1440
Mailing Address - Fax:209-550-4903
Practice Address - Street 1:1414 N CALIFORNIA ST FL 2
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1515
Practice Address - Country:US
Practice Address - Phone:209-468-4244
Practice Address - Fax:209-468-4539
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional