MEDICARE: KAYLA RICHELE MARIE MULHOLLAND 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	114402	CA

General Provider Information

NPI Number	:	1154199826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA RICHELE MARIE MULHOLLAND LCSW

Provider Business Mailing Address
First Line	:	3245 UNIVERSITY AVE STE 1 #333
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2249 IRIS AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-3910
Country	:	US
Telephone Number	:	415-425-5595
Fax Number	:

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

Provider Enumeration Date	:	12/12/2023
Last Update Date	:	12/12/2023

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