Provider Demographics
NPI:1952156549
Name:KRISTA REGEDANZ, PHD, A PSYCHOLOGICAL ORGANIZATION
Entity Type:Organization
Organization Name:KRISTA REGEDANZ, PHD, A PSYCHOLOGICAL ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:REGEDANZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSY23220
Authorized Official - Phone:650-248-0754
Mailing Address - Street 1:4370 ALPINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTOLA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94028-7953
Mailing Address - Country:US
Mailing Address - Phone:650-248-0754
Mailing Address - Fax:
Practice Address - Street 1:4370 ALPINE RD STE 200
Practice Address - Street 2:
Practice Address - City:PORTOLA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94028-7953
Practice Address - Country:US
Practice Address - Phone:650-248-0754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty