Provider Demographics
NPI:1881651693
Name:HOOD, KENNETH W (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:W
Last Name:HOOD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 ALHAMBRA BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3825
Mailing Address - Country:US
Mailing Address - Phone:916-441-1925
Mailing Address - Fax:916-441-0367
Practice Address - Street 1:718 ALHAMBRA BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3825
Practice Address - Country:US
Practice Address - Phone:916-441-1925
Practice Address - Fax:916-441-0367
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10623103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR23651Medicare UPIN
CAOPL 106230Medicare ID - Type Unspecified