Provider Demographics
NPI:1609146737
Name:MARVIN, KRISTIN (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MARVIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 OFARRELL ST
Mailing Address - Street 2:STE. 250
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1386
Mailing Address - Country:US
Mailing Address - Phone:650-645-1100
Mailing Address - Fax:650-645-1195
Practice Address - Street 1:1781 E FIR AVE
Practice Address - Street 2:STE. 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3840
Practice Address - Country:US
Practice Address - Phone:650-645-1100
Practice Address - Fax:650-645-1195
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23836103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical