Provider Demographics
NPI:1346681632
Name:ALCANTARA, LEAN CASTRO (JD)
Entity Type:Individual
Prefix:MR
First Name:LEAN
Middle Name:CASTRO
Last Name:ALCANTARA
Suffix:
Gender:M
Credentials:JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 TEDESCHI DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-4206
Mailing Address - Country:US
Mailing Address - Phone:707-478-2653
Mailing Address - Fax:
Practice Address - Street 1:900 5TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2928
Practice Address - Country:US
Practice Address - Phone:415-457-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health