Provider Demographics
NPI:1992535389
Name:ENGLISH, KEVIN CARL
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:CARL
Last Name:ENGLISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WHITE BIRCH CT APT D
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-1979
Mailing Address - Country:US
Mailing Address - Phone:856-203-0090
Mailing Address - Fax:
Practice Address - Street 1:204 ARK RD STE 104F
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3190
Practice Address - Country:US
Practice Address - Phone:856-314-5307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00758300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health