Healthcare Provider Details

I. General information

NPI: 1629348305
Provider Name (Legal Business Name): MARHYA JUSTINE KELSCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARHYA JUSTINE KELSCH-ANDERSON

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19630 ALLENDALE AVE #2146
SARATOGA CA
95070-0146
US

IV. Provider business mailing address

PO BOX 2146
SARATOGA CA
95070-0146
US

V. Phone/Fax

Practice location:
  • Phone: 510-552-2327
  • Fax:
Mailing address:
  • Phone: 510-552-2327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW60097
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-1994
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: