Provider Demographics
NPI:1861516783
Name:DELK, KERRY K (PHD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:K
Last Name:DELK
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 1:20371 IRVINE AVE
Mailing Address - Street 2:STE A160
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-5651
Mailing Address - Country:US
Mailing Address - Phone:714-540-5010
Mailing Address - Fax:714-540-5020
Practice Address - Street 1:20371 IRVINE AVE
Practice Address - Street 2:STE A160
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-5651
Practice Address - Country:US
Practice Address - Phone:714-540-5010
Practice Address - Fax:714-540-5020
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12297103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP12297Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER