Provider Demographics
NPI:1861558967
Name:VAN DE CARR, KRISTIN JANE
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JANE
Last Name:VAN DE CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:JANE
Other - Last Name:VAN DE CARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2 CROW CANYON CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1953
Mailing Address - Country:US
Mailing Address - Phone:925-838-4036
Mailing Address - Fax:925-838-4039
Practice Address - Street 1:2 CROW CANYON CT
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1953
Practice Address - Country:US
Practice Address - Phone:925-838-4036
Practice Address - Fax:925-838-4039
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11296103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical