Provider Demographics
NPI:1093481491
Name:FYRWALD, KRISTINA (ACSW)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:FYRWALD
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 CENTER AVE APT 506
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-9161
Mailing Address - Country:US
Mailing Address - Phone:708-603-9856
Mailing Address - Fax:
Practice Address - Street 1:2716 OCEAN PARK BLVD STE 3075
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5232
Practice Address - Country:US
Practice Address - Phone:310-612-2998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA989941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical