Provider Demographics
NPI:1578747705
Name:KINOSHITA, KEIKO (LCSW)
Entity Type:Individual
Prefix:
First Name:KEIKO
Middle Name:
Last Name:KINOSHITA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 WILSHIRE BLVD., 8TH FL.
Mailing Address - Street 2:DEPT OF MENTAL HEALTH-SFC,
Mailing Address - City:LA
Mailing Address - State:CA
Mailing Address - Zip Code:90010
Mailing Address - Country:US
Mailing Address - Phone:310-717-6603
Mailing Address - Fax:
Practice Address - Street 1:3075 WILSHIRE BLVD., 8TH FL.
Practice Address - Street 2:DEPT OF MENTAL HEALTH-SFC,
Practice Address - City:LA
Practice Address - State:CA
Practice Address - Zip Code:90010
Practice Address - Country:US
Practice Address - Phone:310-717-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA237421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical