Provider Demographics
NPI:1396272464
Name:BARRAGAN, KRISTEN JENIECE
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:JENIECE
Last Name:BARRAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:JENIECE
Other - Last Name:DEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5862 SMOKY QUARTZ LOOP
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-6805
Mailing Address - Country:US
Mailing Address - Phone:408-219-3077
Mailing Address - Fax:
Practice Address - Street 1:5862 SMOKY QUARTZ LOOP
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-6805
Practice Address - Country:US
Practice Address - Phone:408-219-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99376106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist