Provider Demographics
NPI:1336706811
Name:MAGUIRE, KELSIE (PHD, LCSW)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:KELSIE
Other - Middle Name:
Other - Last Name:WEIDENHAMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2339 PALOMIRA CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1239
Mailing Address - Country:US
Mailing Address - Phone:810-240-8502
Mailing Address - Fax:
Practice Address - Street 1:2339 PALOMIRA CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1239
Practice Address - Country:US
Practice Address - Phone:810-240-8502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040109201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical