MEDICARE: ELIZABETH KRAINER PH.D., PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY 24894	CA

General Provider Information

NPI Number	:	1396181194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH KRAINER PH.D., PSY.D.

Provider Business Mailing Address
First Line	:	1235 MARIN AVE STE D
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-2042
Country	:	US
Telephone Number	:	510-981-4563
Fax Number	:	510-647-8160

Provider Business Practice Location Address
First Line	:	1235 MARIN AVE STE D
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-2042
Country	:	US
Telephone Number	:	510-981-4563
Fax Number	:	510-647-8160

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2013
Last Update Date	:	05/20/2013

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