Provider Demographics
NPI:1568869543
Name:DECASTRO, BRIANDA (LMFT)
Entity type:Individual
Prefix:
First Name:BRIANDA
Middle Name:
Last Name:DECASTRO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5098 FOOTHILLS BLVD STE 3-134
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-6526
Mailing Address - Country:US
Mailing Address - Phone:916-865-6833
Mailing Address - Fax:
Practice Address - Street 1:2200 DOUGLAS BLVD STE 140B
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4292
Practice Address - Country:US
Practice Address - Phone:808-381-0532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131679106H00000X, 106H00000X
CA104120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist