Provider Demographics
NPI:1851976203
Name:GUNDEL, KIRSTEN B (LCSW)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:B
Last Name:GUNDEL
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 1:2930 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-2401
Mailing Address - Country:US
Mailing Address - Phone:619-210-9533
Mailing Address - Fax:
Practice Address - Street 1:2930 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-2401
Practice Address - Country:US
Practice Address - Phone:619-210-9533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA966111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical