Provider Demographics
NPI:1508582677
Name:ONEIL, KELSEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:ONEIL
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 1:713 DEWITT AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3605
Mailing Address - Country:US
Mailing Address - Phone:617-840-1676
Mailing Address - Fax:
Practice Address - Street 1:1910 OLYMPIC BLVD STE 365
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5096
Practice Address - Country:US
Practice Address - Phone:877-676-7634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1194701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical