Healthcare Provider Details

I. General information

NPI: 1649211996
Provider Name (Legal Business Name): MARJORIE VEGO KRAUSZ ED.D, MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 11/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6994 EL CAMINO REAL STE 205B
CARLSBAD CA
92009-4153
US

IV. Provider business mailing address

6994 EL CAMINO REAL STE 205B
CARLSBAD CA
92009-4153
US

V. Phone/Fax

Practice location:
  • Phone: 760-931-9333
  • Fax: 760-436-5216
Mailing address:
  • Phone: 760-931-9333
  • Fax: 760-436-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number22132
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT9347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: