Basic Information
| Provider Information | |||||||||
| NPI: | 1346306677 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STAFFORD | ||||||||
| FirstName: | KARRIE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2309 PALMETTO AVE STE C1 | ||||||||
| Address2: | |||||||||
| City: | PACIFICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940442736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502733293 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 400 EDMONDS RD | ||||||||
| Address2: | |||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940623803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6508391810 | ||||||||
| FaxNumber: | 6508391463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 09/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 45739 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.