Provider Demographics
NPI:1407675648
Name:AMIDON-BRENT, DARLENE J (AMFT)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:J
Last Name:AMIDON-BRENT
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:
Other - Last Name:AMIDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AMFT
Mailing Address - Street 1:4842 BERNAL AVE APT C
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-1182
Mailing Address - Country:US
Mailing Address - Phone:408-768-0890
Mailing Address - Fax:
Practice Address - Street 1:4842 BERNAL AVE APT C
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-1182
Practice Address - Country:US
Practice Address - Phone:408-768-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150285106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist