Provider Demographics
NPI:1265939862
Name:AIELLO, KERRIE LYN
Entity type:Individual
Prefix:MRS
First Name:KERRIE
Middle Name:LYN
Last Name:AIELLO
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 1:3435 CAMINO DEL RIO S STE 121
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3910
Mailing Address - Country:US
Mailing Address - Phone:619-823-7481
Mailing Address - Fax:
Practice Address - Street 1:3435 CAMINO DEL RIO S STE 121
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3910
Practice Address - Country:US
Practice Address - Phone:619-823-7481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA619431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical