Provider Demographics
NPI:1215284211
Name:CALDERON, BROOKE ALLISON (MFT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALLISON
Last Name:CALDERON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:A
Other - Last Name:HATCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2940 CAMINO DIABLO STE 110
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3983
Mailing Address - Country:US
Mailing Address - Phone:925-201-6536
Mailing Address - Fax:925-201-6925
Practice Address - Street 1:2940 CAMINO DIABLO STE 110
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-3983
Practice Address - Country:US
Practice Address - Phone:925-201-6536
Practice Address - Fax:925-201-6925
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109707106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist