Kristin Joy Reynolds Brada

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

27689 Issued in CA

Practice address

3020 Children'S Way
MC 5100
San Diego, CA 92123

Phone

(858) 576-1700

Fax

(858) 966-7573

NPI assigned

Jun 10, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kristin Joy Reynolds Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1591747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1366067951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDREN'S WAY",
            "address_2": "MC 5100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92123",
            "telephone_number": "858-576-1700",
            "fax_number": "858-966-7573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 CHILDREN'S WAY",
            "address_2": "MC 5100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92123",
            "telephone_number": "858-576-1700",
            "fax_number": "858-966-7573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADA",
        "first_name": "KRISTIN",
        "middle_name": "JOY REYNOLDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-10",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "27689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "REYNOLDS",
            "middle_name": "JOY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rachel Elizabeth Brackett, MS, OTR/L
• Samantha Lynne Brackett, MD
• Mary Joan Brackin, HEALTH COACH
• Nora Villarazo Brackin, NURSE
• Douglas Brackmann, PH.D.
• Jennie Bradach
• Suzanne Elise Bradbury, PHARM.D.07/04/1972
• Adam Lawrence Braddock, MD
• Lori Marie Braddock
• Deborah Anne Bradel, RN PHN

• Clinical Social Worker in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; 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.