Provider Demographics
NPI:1467044834
Name:POPPMEIER, TAYLOR MACKENZIE (LCSW)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MACKENZIE
Last Name:POPPMEIER
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 1:1233 ARCHER ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1228
Mailing Address - Country:US
Mailing Address - Phone:619-483-1663
Mailing Address - Fax:619-431-4565
Practice Address - Street 1:1233 ARCHER ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-1228
Practice Address - Country:US
Practice Address - Phone:619-483-1663
Practice Address - Fax:619-431-4565
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1086631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical