Provider Demographics
NPI:1184450322
Name:GIOSCIA, KRISTEN NICOLE
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:NICOLE
Last Name:GIOSCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 AVENIDA DE LA ESTRELLA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3987
Mailing Address - Country:US
Mailing Address - Phone:949-891-2432
Mailing Address - Fax:
Practice Address - Street 1:324 AVENIDA DE LA ESTRELLA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3987
Practice Address - Country:US
Practice Address - Phone:949-891-2432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT149665106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist