Basic Information
| Provider Information | |||||||||
| NPI: | 1598431363 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEINMAN | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | BSW, RADT-1 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 JUANITA WAY | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941271736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154188962 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4049 MILLER WAY | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958171332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164519312 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2021 | ||||||||
| LastUpdateDate: | 08/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 9756863 | 01 | CA | KAISER | OTHER |