Provider Demographics
NPI:1568659696
Name:KRACHT, ROBERTA GARCIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:GARCIA
Last Name:KRACHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17705 HALE AVE STE H6
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4347
Mailing Address - Country:US
Mailing Address - Phone:408-778-3243
Mailing Address - Fax:408-779-8829
Practice Address - Street 1:17705 HALE AVE STE H6
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4347
Practice Address - Country:US
Practice Address - Phone:408-778-3243
Practice Address - Fax:408-779-8829
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 11982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17249ZMedicare PIN