MEDICARE: KRISTIN MARIE MASLIC LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	65307	CA

General Provider Information

NPI Number	:	1477703437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MARIE MASLIC LCSW

Provider Business Mailing Address
First Line	:	5255 STEVENS CREEK BLVD # 257
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-6664
Country	:	US
Telephone Number	:	408-877-6061
Fax Number	:

Provider Business Practice Location Address
First Line	:	5255 STEVENS CREEK BLVD # 257
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-6664
Country	:	US
Telephone Number	:	408-877-6061
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2008
Last Update Date	:	02/11/2022

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