Provider Demographics
NPI:1801385372
Name:PRIVETTE, KASEY
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:PRIVETTE
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 1:1950 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-1720
Mailing Address - Country:US
Mailing Address - Phone:951-530-5900
Mailing Address - Fax:951-530-5945
Practice Address - Street 1:1950 MARKET ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1720
Practice Address - Country:US
Practice Address - Phone:951-530-5900
Practice Address - Fax:951-530-5945
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW99967106H00000X, 101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator