Provider Demographics
NPI:1770929432
Name:KRASKIN, CHRISTOPHER (LCSW)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:KRASKIN
Suffix:
Gender:M
Credentials:LCSW
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 1122
Mailing Address - Street 2:
Mailing Address - City:BLUE JAY
Mailing Address - State:CA
Mailing Address - Zip Code:92317-1122
Mailing Address - Country:US
Mailing Address - Phone:909-337-5953
Mailing Address - Fax:909-337-5953
Practice Address - Street 1:28545 STATE HWY 18
Practice Address - Street 2:
Practice Address - City:SKYFOREST
Practice Address - State:CA
Practice Address - Zip Code:92385
Practice Address - Country:US
Practice Address - Phone:909-336-1800
Practice Address - Fax:909-336-0990
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 288051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical