Provider Demographics
NPI:1659417657
Name:KAPASH, KEITH (MS, MFT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:KAPASH
Suffix:
Gender:M
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HALLIDIE PLAZA
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102
Mailing Address - Country:US
Mailing Address - Phone:415-450-9644
Mailing Address - Fax:415-450-9644
Practice Address - Street 1:1 HALLIDIE PLAZA
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-2841
Practice Address - Country:US
Practice Address - Phone:415-450-9644
Practice Address - Fax:415-450-9644
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11577Medicaid