Provider Demographics
NPI:1306867403
Name:MUNOZ-KIEHNE, MARISOL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARISOL
Middle Name:
Last Name:MUNOZ-KIEHNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARISOL
Other - Middle Name:
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:3230 KERNER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-4840
Mailing Address - Country:US
Mailing Address - Phone:415-473-6787
Mailing Address - Fax:415-473-3080
Practice Address - Street 1:3230 KERNER BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4840
Practice Address - Country:US
Practice Address - Phone:415-473-6787
Practice Address - Fax:415-473-3080
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14096103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical