Provider Demographics
NPI:1760820104
Name:JANEWAY, KEVIN BRIAN
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:BRIAN
Last Name:JANEWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ART
Other - Middle Name:
Other - Last Name:FORM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 POLI ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-4964
Mailing Address - Country:US
Mailing Address - Phone:805-247-0750
Mailing Address - Fax:805-247-0754
Practice Address - Street 1:426 W. 5TH STREET
Practice Address - Street 2:OXNARD CLUBHOUSE
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030
Practice Address - Country:US
Practice Address - Phone:805-247-0750
Practice Address - Fax:805-247-0754
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health