Provider Demographics
NPI:1508102294
Name:CRIADO, KRISTEN KEHAULANI (PHD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:KEHAULANI
Last Name:CRIADO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:KEHAULANI
Other - Last Name:MARCIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1920 BRIARCLIFF ROAD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329
Mailing Address - Country:US
Mailing Address - Phone:404-785-9352
Mailing Address - Fax:
Practice Address - Street 1:1920 BRIARCLIFF ROAD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329
Practice Address - Country:US
Practice Address - Phone:404-785-9352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8682103TC0700X
GAPSY003650103T00000X
FLPY8682103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical