Provider Demographics
NPI:1023843406
Name:MAZARIEGOS, KEILA SARAI (ACSW)
Entity type:Individual
Prefix:
First Name:KEILA
Middle Name:SARAI
Last Name:MAZARIEGOS
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 W PEDREGOSA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-4010
Mailing Address - Country:US
Mailing Address - Phone:805-451-0441
Mailing Address - Fax:
Practice Address - Street 1:2504 REFUGIO RD
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-9778
Practice Address - Country:US
Practice Address - Phone:805-243-0199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100538104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health