Healthcare Provider Details

I. General information

NPI: 1750097515
Provider Name (Legal Business Name): KELSEY PIETRO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24436 ISLAND AVE
CARSON CA
90745-6540
US

IV. Provider business mailing address

24436 ISLAND AVE
CARSON CA
90745-6540
US

V. Phone/Fax

Practice location:
  • Phone: 310-266-7072
  • Fax:
Mailing address:
  • Phone: 310-266-7072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KELSEY MICHELLE PIETRO
Title or Position: OWNER
Credential: PSY. D.
Phone: 310-266-7072