Kelly Bordman, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

200 Michigan Ave
Vista, CA 92084-5424

Phone

(760) 726-4900

Fax

(760) 631-5633

NPI assigned

Mar 5, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677024000000",
    "number": "1184753980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3255 CAMINO DEL RIO S",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083806",
            "telephone_number": "619-307-3977",
            "fax_number": "619-563-2775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MICHIGAN AVE",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920845424",
            "telephone_number": "760-726-4900",
            "fax_number": "760-631-5633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDMAN",
        "first_name": "KELLY",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "69179",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASW INTERN REGISTRATION #",
            "identifier": "23635",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aurianna Rose Bonanno
• Wendy Lynn Bonnar
• Debra Ann Booman, D.V.M.
• Michael Alexander Booth, MFT
• Enrique M. Boquin, M.D.
• Kathleen Ann Borgeson, LCSW
• Jazmyne Arteese Bosley, NP
• Reid Elliot Bouchard, DPT
• Hilary Mara Bowers, MD
• Caleb S Bradford

• Mental Health Counselor in Vista, CA
• Providers in Vista, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.