Healthcare Provider Details

I. General information

NPI: 1346906914
Provider Name (Legal Business Name): KYLAH BREANN LUCY HERVEY ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 OLD BAYSHORE HWY STE 201
BURLINGAME CA
94010-1616
US

IV. Provider business mailing address

4304 18TH ST UNIT 14081
SAN FRANCISCO CA
94114-9002
US

V. Phone/Fax

Practice location:
  • Phone: 800-913-2615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: