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General NPI Number Information
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NPI Number | 1477995249
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Entity Type | Individual
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Provider Name | KELLY DANAE LOFTIS LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 6041 CADILLAC AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-1702
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Country | US
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Telephone | 323-857-2729
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Fax |
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Provider Business Mailing Address
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Address Line | 3350 LAJOLLA VILLAGE DRIVE 118S
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City | SAN DIEGO
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State | CA
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Zip | 92161-0001
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Country | US
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Telephone | 858-232-7991
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW09924003
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW70491
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License Number State | CA
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