Provider Demographics
NPI:1790094282
Name:PUTANSU, KEVIN P (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:P
Last Name:PUTANSU
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE 600-A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-3248
Mailing Address - Country:US
Mailing Address - Phone:352-262-5753
Mailing Address - Fax:
Practice Address - Street 1:408 W UNIVERSITY AVE
Practice Address - Street 2:SUITE 600-A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-3248
Practice Address - Country:US
Practice Address - Phone:352-262-5753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW70391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical