Provider Demographics
NPI:1730806225
Name:BADRE, KIRSTEN (LCSW)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:BADRE
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 1:4142 ADAMS AVE # 103-211
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2592
Mailing Address - Country:US
Mailing Address - Phone:859-608-2430
Mailing Address - Fax:
Practice Address - Street 1:2333 CAMINO DEL RIO S STE 160
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3617
Practice Address - Country:US
Practice Address - Phone:619-798-6106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1112061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical