Provider Demographics
NPI:1487664868
Name:LOVE, KRISTEN MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:MARIE
Last Name:LOVE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:MARIE
Other - Last Name:DARBANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, PPS
Mailing Address - Street 1:2750 SUTTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-1024
Mailing Address - Country:US
Mailing Address - Phone:916-492-7240
Mailing Address - Fax:916-736-1072
Practice Address - Street 1:2750 SUTTERVILLE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1024
Practice Address - Country:US
Practice Address - Phone:916-492-7240
Practice Address - Fax:916-736-1072
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6804OtherSACRAMENTO COUNTY MH ID#