Provider Demographics
NPI:1467590653
Name:NOVOTNY, KRISTINE ANNE (MA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:ANNE
Last Name:NOVOTNY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:KRISTINE
Other - Middle Name:ANNE
Other - Last Name:ZELEZNAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:7915 VISTA NUEZ
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009
Mailing Address - Country:US
Mailing Address - Phone:760-688-8922
Mailing Address - Fax:
Practice Address - Street 1:2558 ROOSEVELT ST STE 304
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1672
Practice Address - Country:US
Practice Address - Phone:760-688-8922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 51348106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0408170OtherBLUE CROSS BLUE SHIELD
CAMFC 51348OtherMFT