Provider Demographics
NPI:1972793131
Name:KINNEY, DAVID B (MA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:KINNEY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 WILLOW VALE WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4102
Mailing Address - Country:US
Mailing Address - Phone:916-716-1024
Mailing Address - Fax:916-684-4201
Practice Address - Street 1:2101 STONE BLVD
Practice Address - Street 2:SUITE 240 SACRAMENTO FAMILY THERAPY
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-4056
Practice Address - Country:US
Practice Address - Phone:916-716-1024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52525106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8265Medicare PIN