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General NPI Number Information
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NPI Number | 1093481491
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Entity Type | Individual
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Provider Name | KRISTINA FYRWALD ACSW
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Gender | Female
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 2716 OCEAN PARK BLVD STE 3075
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City | SANTA MONICA
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State | CA
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Zip | 90405-5232
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Country | US
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Telephone | 310-612-2998
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Fax |
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Provider Business Mailing Address
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Address Line | 7402 CENTER AVE APT 506
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-9161
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Country | US
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Telephone | 708-603-9856
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 98994
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License Number State | CA
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