Healthcare Provider Details

I. General information

NPI: 1659843563
Provider Name (Legal Business Name): KELSEY M BISHOP MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 BEVERLY BLVD
LOS ANGELES CA
90057-2220
US

IV. Provider business mailing address

2330 BEVERLY BLVD
LOS ANGELES CA
90057-2220
US

V. Phone/Fax

Practice location:
  • Phone: 213-744-0724
  • Fax: 213-342-3124
Mailing address:
  • Phone: 213-381-0540
  • Fax: 213-342-3124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW86585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: