Provider Demographics
NPI:1003975855
Name:GUZMAN PARK, SHANDRA (LMFT)
Entity Type:Individual
Prefix:
First Name:SHANDRA
Middle Name:
Last Name:GUZMAN PARK
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 1:20200 REDWOOD RD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4353
Mailing Address - Country:US
Mailing Address - Phone:510-283-9499
Mailing Address - Fax:
Practice Address - Street 1:20200 REDWOOD RD
Practice Address - Street 2:SUITE #6
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4353
Practice Address - Country:US
Practice Address - Phone:510-283-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist