Provider Demographics
NPI:1598781239
Name:GOOD, KRISTIN B (PSYD-L)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:B
Last Name:GOOD
Suffix:
Gender:F
Credentials:PSYD-L
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:B
Other - Last Name:GOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSY D
Mailing Address - Street 1:2532 SANTA CLARA AVE. #295
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501
Mailing Address - Country:US
Mailing Address - Phone:510-334-3659
Mailing Address - Fax:415-241-9758
Practice Address - Street 1:165 CAPP ST.
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:415-869-7977
Practice Address - Fax:415-510-8282
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20854103TC0700X
CAPSY20854103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical