Individual
BEVIN NICOLE DEMUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2028 PARK ROYAL DR, SAN JOSE, CA 95125-4648
(650) 305-1044
Mailing address
2028 PARK ROYAL DR, SAN JOSE, CA 95125-4648
(650) 305-1044
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW75553
CA
1041C0700X
Clinical Social Worker
LCSW75553
CA
Other
Enumeration date
07/01/2014
Last updated
01/19/2021
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