Provider Demographics
NPI:1710991567
Name:MCQUARY, KRISTEN (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MCQUARY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MARIE
Other - Last Name:PEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW
Mailing Address - Street 1:2021 YARNELL WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7117
Mailing Address - Country:US
Mailing Address - Phone:916-671-9029
Mailing Address - Fax:
Practice Address - Street 1:25 CADILLAC DR
Practice Address - Street 2:SUITE 212
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-8349
Practice Address - Country:US
Practice Address - Phone:916-671-9029
Practice Address - Fax:916-979-6110
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 17045104100000X
CALCS292291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker