Provider Demographics
NPI:1497764757
Name:KESTEN, DENISE ELAINE (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ELAINE
Last Name:KESTEN
Suffix:
Gender:F
Credentials:MSW LCSW
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 1713
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-1713
Mailing Address - Country:US
Mailing Address - Phone:831-915-4475
Mailing Address - Fax:
Practice Address - Street 1:311 FOREST AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-3367
Practice Address - Country:US
Practice Address - Phone:831-915-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 101491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS101490OtherPROVIDER # BLUE SHIELD
CAZZZ29258ZMedicare ID - Type UnspecifiedPROVIDER #