Provider Demographics
NPI:1659820769
Name:RADMANESH, KELSEY
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:
Last Name:RADMANESH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 87TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2928
Mailing Address - Country:US
Mailing Address - Phone:727-580-0985
Mailing Address - Fax:
Practice Address - Street 1:1290 87TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2928
Practice Address - Country:US
Practice Address - Phone:727-580-0985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker