Basic Information
| Provider Information | |||||||||
| NPI: | 1720670987 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARPENETTI | ||||||||
| FirstName: | KRISTINA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | RADT I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 SNEATH LN | ||||||||
| Address2: | |||||||||
| City: | SAN BRUNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940662308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502441444 | ||||||||
| FaxNumber: | 6502441447 | ||||||||
| Practice Location | |||||||||
| Address1: | 1724 BRYANT ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941101406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155589125 | ||||||||
| FaxNumber: | 4155589160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2021 | ||||||||
| LastUpdateDate: | 02/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | R1395350620 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.