Provider Demographics
NPI:1588715155
Name:BUNCH, KEVIN SEAN (PSY D)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SEAN
Last Name:BUNCH
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 MAIN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-1102
Mailing Address - Country:US
Mailing Address - Phone:925-315-5277
Mailing Address - Fax:
Practice Address - Street 1:535 MAIN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-1102
Practice Address - Country:US
Practice Address - Phone:925-315-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103TC2200X
CAPSY24580103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA103TC0700XMedicaid
CA103TC0700XOtherSTAFF ID
CA5188OtherSTAFF ID #