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General NPI Number Information
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NPI Number | 1427173772
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Entity Type | Individual
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Provider Name | ERICA KRUSEN MFT INTERN
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 04/21/2010
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Provider Practice Location Address
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Address Line | 3030 OLYMPIC BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90404-5073
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Country | US
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Telephone | 310-581-8729
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Fax |
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Provider Business Mailing Address
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Address Line | 3030 OLYMPIC BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90404-5073
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Country | US
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Telephone |
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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 | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 47181
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License Number State | CA
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