Healthcare Provider Details

I. General information

NPI: 1619009396
Provider Name (Legal Business Name): KELLY DANAE WARNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 N CANON DR STE 209
BEVERLY HILLS CA
90210-4897
US

IV. Provider business mailing address

4935 RIGOLETTO ST
WOODLAND HILLS CA
91364-2816
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-9999
  • Fax:
Mailing address:
  • Phone: 818-486-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS20697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: