Provider Demographics
NPI:1265750137
Name:KIS, ERIKA VIOLET (PHD)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:VIOLET
Last Name:KIS
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:111 DEERWOOD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4445
Mailing Address - Country:US
Mailing Address - Phone:925-270-4499
Mailing Address - Fax:925-270-4499
Practice Address - Street 1:111 DEERWOOD RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4445
Practice Address - Country:US
Practice Address - Phone:925-270-4499
Practice Address - Fax:925-270-4499
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22828103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical