Provider Demographics
NPI:1154545275
Name:KINCAID, JOHN EDWARD (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:KINCAID
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 1:315 DIABLO RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-3409
Mailing Address - Country:US
Mailing Address - Phone:925-946-5471
Mailing Address - Fax:925-838-2146
Practice Address - Street 1:315 DIABLO RD
Practice Address - Street 2:SUITE 222
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3409
Practice Address - Country:US
Practice Address - Phone:925-946-5471
Practice Address - Fax:925-838-2146
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7489103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1675727Medicare PIN
CAR27737Medicare UPIN