Provider Demographics
NPI:1356481055
Name:KILLEN-HARVEY, ALBERT (LCSW)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:KILLEN-HARVEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 219
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3812
Mailing Address - Country:US
Mailing Address - Phone:619-683-8153
Mailing Address - Fax:
Practice Address - Street 1:3110 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 219
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3812
Practice Address - Country:US
Practice Address - Phone:619-683-8153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS167861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical