Provider Demographics
NPI:1619611456
Name:KELSEY BARBIERI, LICENSED CLINICAL SOCIAL WORKER, A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:KELSEY BARBIERI, LICENSED CLINICAL SOCIAL WORKER, A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBIERI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:760-454-7244
Mailing Address - Street 1:1741 EASTLAKE PKWY STE 102-122
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2032
Mailing Address - Country:US
Mailing Address - Phone:760-454-7244
Mailing Address - Fax:
Practice Address - Street 1:1741 EASTLAKE PKWY STE 102-122
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-2032
Practice Address - Country:US
Practice Address - Phone:760-454-7244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty