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NPI Code Detail

MEDICARE: MISS KELLY MARIE LAVAN LCSW

MEDICARE: MISS KELLY MARIE LAVAN 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
1104100000XSocial Worker113100CA
21041C0700XClinical Social Worker136588CA
3104100000XSocial WorkerNY

General Provider Information

NPI Number : 1932870276
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KELLY MARIE LAVAN LCSW
Provider Business Mailing Address
First Line : 6145 IMPERIAL AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92114-4213
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6145 IMPERIAL AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92114-4213
Country : US
Telephone Number : 619-234-8888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2021
Last Update Date : 01/23/2026

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Directions to “ MISS KELLY MARIE LAVAN LCSW” Practice Location

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