Provider Demographics
NPI:1760971436
Name:GUSENKOV, KATHY V
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:V
Last Name:GUSENKOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 GRANADA DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-1326
Mailing Address - Country:US
Mailing Address - Phone:925-681-9973
Mailing Address - Fax:
Practice Address - Street 1:STE CONSULTANTS, LLC
Practice Address - Street 2:3650 MT. DIABLO BLVD., SUITE 107
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549
Practice Address - Country:US
Practice Address - Phone:510-665-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty