Provider Demographics
NPI:1922146497
Name:GERMANOW, KENNETH HOWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:HOWARD
Last Name:GERMANOW
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 1:356 MANZANITA DR
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3616
Mailing Address - Country:US
Mailing Address - Phone:805-596-5146
Mailing Address - Fax:
Practice Address - Street 1:620 CALIFORNIA BLVD
Practice Address - Street 2:SUITE P
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2541
Practice Address - Country:US
Practice Address - Phone:805-596-5146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10096103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical