MEDICARE: MS. KAYE MARY BRINDLEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	134725	CA

General Provider Information

NPI Number	:	1053276816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAYE MARY BRINDLEY LCSW

Provider Business Mailing Address
First Line	:	2100 ELOISE AVE
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-4306
Country	:	US
Telephone Number	:	989-657-9516
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 ELOISE AVE
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-4306
Country	:	US
Telephone Number	:	530-328-0018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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