Provider Demographics
NPI:1174754733
Name:KAVNER, CAROLYN (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:KAVNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 WILLOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3340
Mailing Address - Country:US
Mailing Address - Phone:323-314-7551
Mailing Address - Fax:
Practice Address - Street 1:5743 CORSA AVE
Practice Address - Street 2:206
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4027
Practice Address - Country:US
Practice Address - Phone:323-314-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22319103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist