Provider Demographics
NPI:1720415789
Name:MADRID, DEENA MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:DEENA
Middle Name:MARIE
Last Name:MADRID
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:DEENA
Other - Middle Name:MARIE
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:325 W WASHINGTON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1946
Mailing Address - Country:US
Mailing Address - Phone:956-405-2831
Mailing Address - Fax:
Practice Address - Street 1:1625 NEWTON AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-1012
Practice Address - Country:US
Practice Address - Phone:956-405-2831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist