Provider Demographics
NPI:1073706909
Name:PASTRANA, BRENDA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:PASTRANA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 ALDER RD
Mailing Address - Street 2:BOX 339500
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:98433-9500
Mailing Address - Country:US
Mailing Address - Phone:253-966-8357
Mailing Address - Fax:253-968-3349
Practice Address - Street 1:1450 ALDER RD
Practice Address - Street 2:BOX 339500
Practice Address - City:JOINT BASE LEWIS-MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98433-9500
Practice Address - Country:US
Practice Address - Phone:253-966-8357
Practice Address - Fax:253-968-3349
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-120211041C0700X
TXLCSW 523231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical