Provider Demographics
NPI:1649605486
Name:MCCORD, KELLY ANN (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:MCCORD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4536 RINETTI LN
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3311
Mailing Address - Country:US
Mailing Address - Phone:626-319-5951
Mailing Address - Fax:
Practice Address - Street 1:4536 RINETTI LN
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3311
Practice Address - Country:US
Practice Address - Phone:626-498-2683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS179311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical