Provider Demographics
NPI:1073648523
Name:RANGEL, KRISTIN LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:LYNN
Last Name:RANGEL
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 1:22031 MAIN ST UNIT 27
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2972
Mailing Address - Country:US
Mailing Address - Phone:310-816-0616
Mailing Address - Fax:
Practice Address - Street 1:1433 S ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3414
Practice Address - Country:US
Practice Address - Phone:310-785-2121
Practice Address - Fax:310-553-6052
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 186391041C0700X
CALCS 248131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical