Provider Demographics
NPI:1093467151
Name:CROVELLA, KERI
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:CROVELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9987 FALCON BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3439
Mailing Address - Country:US
Mailing Address - Phone:619-322-5692
Mailing Address - Fax:
Practice Address - Street 1:9987 FALCON BLUFF ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3439
Practice Address - Country:US
Practice Address - Phone:619-322-5692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool