Provider Demographics
NPI:1396179354
Name:SANTAFERRARO, KJIRSTEN ELAINE (MED, HD, LPCC)
Entity Type:Individual
Prefix:
First Name:KJIRSTEN ELAINE
Middle Name:
Last Name:SANTAFERRARO
Suffix:
Gender:F
Credentials:MED, HD, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11277 GARDEN GROVE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1300
Mailing Address - Country:US
Mailing Address - Phone:714-318-6295
Mailing Address - Fax:
Practice Address - Street 1:11277 GARDEN GROVE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1300
Practice Address - Country:US
Practice Address - Phone:714-318-6295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3878101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional