Provider Demographics
NPI:1417005687
Name:AGNEW, KATHLEEN GILL (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:GILL
Last Name:AGNEW
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 1:12797 VIA FELINO
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3805
Mailing Address - Country:US
Mailing Address - Phone:858-922-8754
Mailing Address - Fax:858-481-8754
Practice Address - Street 1:12797 VIA FELINO
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3805
Practice Address - Country:US
Practice Address - Phone:858-922-8754
Practice Address - Fax:858-481-8754
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical