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General NPI Number Information
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NPI Number | 1700957875
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Entity Type | Individual
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Provider Name | ELENA KONSTANTINOVA KALOYANOVA LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/12/2006
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 1330 LINCOLN AVE STE 106B
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2141
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Country | US
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Telephone | 510-388-2130
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Fax | 510-550-1975
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Provider Business Mailing Address
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Address Line | 1330 LINCOLN AVE STE 106B
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2141
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Country | US
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Telephone | 510-388-2130
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Fax | 510-550-1975
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF42092
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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 | MFT46945
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License Number State | CA
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