Provider Demographics
NPI:1316402191
Name:KLINE, MARICELLA ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARICELLA
Middle Name:ELIZABETH
Last Name:KLINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3450
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95381-3450
Mailing Address - Country:US
Mailing Address - Phone:209-664-8044
Mailing Address - Fax:
Practice Address - Street 1:2101 GEER RD STE 120
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2456
Practice Address - Country:US
Practice Address - Phone:209-664-8044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91806101YP2500X, 1041S0200X
1041C0700X, 390200000X
CA1157281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program