Provider Demographics
NPI:1811982697
Name:KALINOWSKI, JERYL (LCSW)
Entity type:Individual
Prefix:
First Name:JERYL
Middle Name:
Last Name:KALINOWSKI
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 1:5675 RUFFIN RD
Mailing Address - Street 2:325
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1424
Mailing Address - Country:US
Mailing Address - Phone:858-467-9170
Mailing Address - Fax:858-467-9179
Practice Address - Street 1:5675 RUFFIN RD
Practice Address - Street 2:325
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1424
Practice Address - Country:US
Practice Address - Phone:858-467-9170
Practice Address - Fax:858-467-9179
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT512360335011041C0700X
CA277721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical