Healthcare Provider Details

I. General information

NPI: 1447182787
Provider Name (Legal Business Name): KYRA DANIELLE MONAE LEE MSW, ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 BROADWAY ST STE 104
LAGUNA BEACH CA
92651-1816
US

IV. Provider business mailing address

303 BROADWAY ST STE 104
LAGUNA BEACH CA
92651-1816
US

V. Phone/Fax

Practice location:
  • Phone: 415-508-7481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW138978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: