Provider Demographics
NPI:1316618614
Name:REIN, KELLY NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:NICOLE
Last Name:REIN
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 1:4231 BALBOA AVE # 622
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5504
Mailing Address - Country:US
Mailing Address - Phone:760-410-8609
Mailing Address - Fax:858-544-0364
Practice Address - Street 1:2423 CAMINO DEL RIO S STE 205
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3735
Practice Address - Country:US
Practice Address - Phone:760-410-8609
Practice Address - Fax:858-544-0364
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-26
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1018351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical