Provider Demographics
NPI:1811048671
Name:GREGG, KENNETH D (LCSW)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:D
Last Name:GREGG
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Gender:M
Credentials:LCSW
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Mailing Address - Street 1:1425 S MAIN ST
Mailing Address - Street 2:KAISER PERMANENTE, MENTAL HEALTH DEPT
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5318
Mailing Address - Country:US
Mailing Address - Phone:925-295-4145
Mailing Address - Fax:925-295-5226
Practice Address - Street 1:710 S BROADWAY
Practice Address - Street 2:KAISER PERMANENTE, MENTAL HEALTH DEPT
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5294
Practice Address - Country:US
Practice Address - Phone:925-295-4145
Practice Address - Fax:925-295-5226
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2022-01-03
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Provider Licenses
StateLicense IDTaxonomies
CALCS 192411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical