Provider Demographics
NPI:1104570803
Name:WEISENBERGER, KELI-RAE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KELI-RAE
Middle Name:
Last Name:WEISENBERGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24655 MOONLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-7299
Mailing Address - Country:US
Mailing Address - Phone:951-520-6168
Mailing Address - Fax:
Practice Address - Street 1:24655 MOONLIGHT DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-7299
Practice Address - Country:US
Practice Address - Phone:951-520-6168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1020641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical