Provider Demographics
NPI:1659380897
Name:KRESCH, DEBRA K (LCSW, MFT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:KRESCH
Suffix:
Gender:F
Credentials:LCSW, MFT
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:KIMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, MFT
Mailing Address - Street 1:885 ROBERT LN
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5640
Mailing Address - Country:US
Mailing Address - Phone:760-436-6892
Mailing Address - Fax:760-944-6892
Practice Address - Street 1:701 GARDEN VIEW CT STE 20
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2464
Practice Address - Country:US
Practice Address - Phone:760-436-6892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS90951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS 9095Medicare UPIN
CASW9095AMedicare ID - Type UnspecifiedLCSW