MEDICARE: DR. KRISTIN DENVER 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	103T00000X	Psychologist	PSB 34997	CA

General Provider Information

NPI Number	:	1972706679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIN DENVER PSY.D

Provider Business Mailing Address
First Line	:	1911 TASSAJARA AVE
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94805-2070
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 MYRTLE ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94607-2525
Country	:	US
Telephone Number	:	510-839-3888
Fax Number	:

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

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	09/15/2010

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