Provider Demographics
NPI:1184879405
Name:KALEMOS, MARK KEVIN (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:KEVIN
Last Name:KALEMOS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4300 SOQUEL DR SPC 90
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2140
Mailing Address - Country:US
Mailing Address - Phone:831-462-3271
Mailing Address - Fax:831-464-8048
Practice Address - Street 1:5905 SOQUEL DR #300
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073
Practice Address - Country:US
Practice Address - Phone:831-462-3271
Practice Address - Fax:831-464-8048
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 248881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical