Provider Demographics
NPI:1285905232
Name:DVORNIK, CARRIE KRISTEN EVENDEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:KRISTEN EVENDEN
Last Name:DVORNIK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3354 SACRAMENTO ST
Mailing Address - Street 2:STE E
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1948
Mailing Address - Country:US
Mailing Address - Phone:415-793-9643
Mailing Address - Fax:
Practice Address - Street 1:3354 SACRAMENTO ST STE E
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118
Practice Address - Country:US
Practice Address - Phone:415-793-9643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24740103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical