Healthcare Provider Details

I. General information

NPI: 1841069416
Provider Name (Legal Business Name): MARILYN JEAN KRIEGER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2023
Last Update Date: 12/25/2023
Certification Date: 12/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 OVERHILL RD
MILL VALLEY CA
94941-1379
US

IV. Provider business mailing address

PO BOX 1116
MILL VALLEY CA
94942-1116
US

V. Phone/Fax

Practice location:
  • Phone: 415-346-5937
  • Fax:
Mailing address:
  • Phone: 415-346-5937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY5060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: