MEDICARE: ADRIENNE KRAWETZ MFT INTERN

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1902971583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE KRAWETZ MFT INTERN

Provider Business Mailing Address
First Line	:	1600 THE ALAMEDA STE 104
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2341
Country	:	US
Telephone Number	:	650-454-4242
Fax Number	:	408-273-6653

Provider Business Practice Location Address
First Line	:	1600 THE ALAMEDA STE 104
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2341
Country	:	US
Telephone Number	:	650-454-4242
Fax Number	:	408-273-6653

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	10/07/2024

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