MEDICARE: CHRISTINE M. KREZEL LISW

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	171M00000X	Case Manager/Care Coordinator
2	1041C0700X	Clinical Social Worker	1201289	OH

General Provider Information

NPI Number	:	1477703965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE M. KREZEL LISW

Provider Business Mailing Address
First Line	:	3801 MIRANDA AVE
Second Line	:	PALO ALTO HEALTH CARE SYSTEM 122/PAD
City	:	PALO ALTO
State	:	CA
Zip	:	94304-1207
Country	:	US
Telephone Number	:	650-493-5000
Fax Number	:	650-849-1286

Provider Business Practice Location Address
First Line	:	5855 SILVER CREEK VALLEY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95138-1059
Country	:	US
Telephone Number	:	408-574-9119
Fax Number	:

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

Provider Enumeration Date	:	09/22/2008
Last Update Date	:	04/03/2019

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