Provider Demographics
NPI:1780875997
Name:KINSFOGEL, KRISTEN M (PHD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:KINSFOGEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 STUDENT HEALTH
Mailing Address - Street 2:UNIVERSITY OF CALIFORNIA-IRVINE
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-5200
Mailing Address - Country:US
Mailing Address - Phone:949-824-4367
Mailing Address - Fax:
Practice Address - Street 1:501 STUDENT HEALTH
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA-IRVINE
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-5200
Practice Address - Country:US
Practice Address - Phone:949-824-4367
Practice Address - Fax:949-824-0323
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18769103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical