Individual
DR. BETH KRACKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
36 WINFIELD ST, SAN FRANCISCO, CA 94110-5141
(415) 517-8865
Mailing address
36 WINFIELD ST, SAN FRANCISCO, CA 94110-5141
(415) 517-8865
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY20522
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPL205221
MEDICARE ID-TYPE UNSPECIFIED
CA
05
—
PSY205220
—
CA
Enumeration date
07/04/2006
Last updated
10/03/2008
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