Provider Demographics
NPI:1417105289
Name:MATTIAS, KRISTIN RENEE
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:RENEE
Last Name:MATTIAS
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 1:225 IRVING ST APT 12
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2626
Mailing Address - Country:US
Mailing Address - Phone:415-706-1370
Mailing Address - Fax:
Practice Address - Street 1:225 IRVING ST APT 12
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2626
Practice Address - Country:US
Practice Address - Phone:415-706-1370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health