| Kelsey Pietro Inc | |
|
24436 Island Ave Carson CA 90745-6540 | |
| (310) 266-7072 | |
| Not Available |
| Full Name | Kelsey Pietro Inc |
|---|---|
| Speciality | Psychologist |
| Location | 24436 Island Ave, Carson, California |
| Authorized Official Name and Position | Kelsey Michelle Pietro (OWNER) |
| Authorized Official Contact | 3102667072 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelsey Pietro Inc 24436 Island Ave Carson CA 90745-6540 Ph: (310) 266-7072 | Kelsey Pietro Inc 24436 Island Ave Carson CA 90745-6540 Ph: (310) 266-7072 |
| NPI Number | 1750097515 |
|---|---|
| Provider Enumeration Date | 01/25/2023 |
| Last Update Date | 07/20/2023 |
| Certification Date | 07/20/2023 |
| Medicare PECOS PAC ID | 8527413723 |
|---|---|
| Medicare Enrollment ID | O20231009000159 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750097515 | NPI | - | NPPES |
| CB296476 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kelsey Pietro |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902303191 PECOS PAC ID: 8022372374 Enrollment ID: I20180514001548 |
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