Provider Demographics
NPI:1316318116
Name:ERAZO, RENE JR (LMFT)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:ERAZO
Suffix:JR
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 S WHITE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-4760
Mailing Address - Country:US
Mailing Address - Phone:510-468-4797
Mailing Address - Fax:310-337-2805
Practice Address - Street 1:35284 LANCERO ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4544
Practice Address - Country:US
Practice Address - Phone:510-468-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114606101YM0800X
CA139630106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty