Provider Demographics
NPI:1952003832
Name:KRALJ, DENISE AGNES (MFT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:AGNES
Last Name:KRALJ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1616
Mailing Address - Country:US
Mailing Address - Phone:415-244-9788
Mailing Address - Fax:
Practice Address - Street 1:2416 CENTRAL AVE # B2
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4516
Practice Address - Country:US
Practice Address - Phone:510-210-3984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49188106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist