Healthcare Provider Details

I. General information

NPI: 1679477764
Provider Name (Legal Business Name): KELSEY DONOHUE-MALATESTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELSEY DONOHUE LMSW/ASW

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7676 HAZARD CENTER DR STE 340
SAN DIEGO CA
92108-4543
US

IV. Provider business mailing address

4755 WILSON AVE APT 2
SAN DIEGO CA
92116-2444
US

V. Phone/Fax

Practice location:
  • Phone: 858-750-7379
  • Fax:
Mailing address:
  • Phone: 610-533-0121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: