MEDICARE: MS. MAUREEN GREGG KROLL MFT

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	106H00000X	Marriage & Family Therapist	44540	CA

General Provider Information

NPI Number	:	1972001659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAUREEN GREGG KROLL MFT

Provider Business Mailing Address
First Line	:	3516 GEARY BLVD
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-3213
Country	:	US
Telephone Number	:	415-339-7430
Fax Number	:

Provider Business Practice Location Address
First Line	:	3516 GEARY BLVD
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-3213
Country	:	US
Telephone Number	:	415-339-7430
Fax Number	:

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

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	01/26/2018

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