Provider Demographics
NPI:1497974968
Name:DECARBONEL, CLAUDETTE ELIZABETH (MFT)
Entity Type:Individual
Prefix:DR
First Name:CLAUDETTE
Middle Name:ELIZABETH
Last Name:DECARBONEL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-2449
Mailing Address - Country:US
Mailing Address - Phone:650-303-0676
Mailing Address - Fax:
Practice Address - Street 1:819 MITTEN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1323
Practice Address - Country:US
Practice Address - Phone:650-303-0676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39077106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC39077OtherMARRIAGE AND FAMILY THERA