Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | ASW 35261 | CA |
Y | 1041S0200X | School Social Worker | LCSW65066 | CA |
NPI | 1003253105 |
---|---|
Provider Name | Kelly Dawne Mcbride |
First Address | East Palo Alto, CA 94303-2550 |
Second Address | Palo Alto, CA 94304-2300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2013 |
Last Update Date | 07/04/2015 |