Provider Demographics
NPI:1346306677
Name:STAFFORD, KARRIE MARIE (MA MFT)
Entity Type:Individual
Prefix:MS
First Name:KARRIE
Middle Name:MARIE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 PALMETTO AVE STE C1
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2736
Mailing Address - Country:US
Mailing Address - Phone:650-273-3293
Mailing Address - Fax:
Practice Address - Street 1:400 EDMONDS RD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-3803
Practice Address - Country:US
Practice Address - Phone:650-839-1810
Practice Address - Fax:650-839-1463
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 45739106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist