Healthcare Provider Details

I. General information

NPI: 1508582677
Provider Name (Legal Business Name): KELSEY ONEIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 OLYMPIC BLVD STE 365
WALNUT CREEK CA
94596-5096
US

IV. Provider business mailing address

713 DEWITT AVE UNIT A
ENCINITAS CA
92024-3605
US

V. Phone/Fax

Practice location:
  • Phone: 877-676-7634
  • Fax:
Mailing address:
  • Phone: 617-840-1676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: