Provider Demographics
NPI:1518158997
Name:BEHRENS, KELLY J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:J
Last Name:BEHRENS
Suffix:
Gender:F
Credentials:PSYD
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Mailing Address - Street 1:3129 MOUNT VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-4738
Mailing Address - Country:US
Mailing Address - Phone:415-971-2494
Mailing Address - Fax:408-360-2396
Practice Address - Street 1:6620 VIA DEL ORO
Practice Address - Street 2:KAISER PERMANENTE ASD CENTER
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119
Practice Address - Country:US
Practice Address - Phone:408-360-2362
Practice Address - Fax:408-360-2396
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2016-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY 23091103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 23091OtherCA BOARD OF PSYCHOLOGY