Provider Demographics
NPI:1164579702
Name:BECERRA, MARINA (LMFT)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:BECERRA
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 1:1460 MARIA LN STE 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5314
Mailing Address - Country:US
Mailing Address - Phone:925-289-9631
Mailing Address - Fax:
Practice Address - Street 1:2311 LOVERIDGE RD FL 2
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5117
Practice Address - Country:US
Practice Address - Phone:925-431-2926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT80241106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5114OtherCONTRA COSTA MENTAL HEALTH SERVICES
CA56725OtherCONTRA COSTA ALCOHOL & OTHER DRUGS SERVICES