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NPI Code Detail

MEDICARE: MISS KELLY MARIE MC HENRY MSW

MEDICARE: MISS KELLY MARIE MC HENRY MSW
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
11041C0700XClinical Social Worker29689CA

General Provider Information

NPI Number : 1851544340
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KELLY MARIE MC HENRY MSW
Provider Business Mailing Address
First Line : 4950 SANTA CRUZ AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92107-3311
Country : US
Telephone Number : 619-552-8585
Fax Number :
Provider Business Practice Location Address
First Line : 1250 6TH AVE STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-4368
Country : US
Telephone Number : 619-515-2430
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2008
Last Update Date : 03/17/2018

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