Provider Demographics
NPI:1518543990
Name:MCNEILL, KELSEY T (LCSW)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:T
Last Name:MCNEILL
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 1:10251 VISTA SORRENTO PKWY STE 280
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3776
Mailing Address - Country:US
Mailing Address - Phone:818-575-6351
Mailing Address - Fax:289-236-3022
Practice Address - Street 1:10251 VISTA SORRENTO PKWY STE 280
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3776
Practice Address - Country:US
Practice Address - Phone:818-575-6351
Practice Address - Fax:289-236-3022
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA818831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical