MEDICARE: DR. TERESA KRAITH PH.D.

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	103TC0700X	Clinical Psychologist	PSY8251	CA

General Provider Information

NPI Number	:	1528179389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA KRAITH PH.D.

Provider Business Mailing Address
First Line	:	2475 MARSHA WAY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-4028
Country	:	US
Telephone Number	:	408-445-1735
Fax Number	:	408-445-2013

Provider Business Practice Location Address
First Line	:	2475 MARSHA WAY
Second Line	:	SAN JOSE
City	:	SAN JOSE
State	:	CA
Zip	:	95125-4028
Country	:	US
Telephone Number	:	408-445-1735
Fax Number	:	408-445-2013

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/18/2010

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