Provider Demographics
NPI:1457704942
Name:KANE, KRISTIN MARIE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:MARIE
Last Name:KANE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1014
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94011-1014
Mailing Address - Country:US
Mailing Address - Phone:650-759-8683
Mailing Address - Fax:
Practice Address - Street 1:25 EDWARDS CT
Practice Address - Street 2:SUITE 101
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-2429
Practice Address - Country:US
Practice Address - Phone:650-759-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90591106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist