Provider Demographics
NPI:1508082298
Name:CASADABAN, ADRIANNE BLANCHE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ADRIANNE
Middle Name:BLANCHE
Last Name:CASADABAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3473 SHANGRI LA RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-2107
Mailing Address - Country:US
Mailing Address - Phone:925-946-9991
Mailing Address - Fax:925-935-3123
Practice Address - Street 1:110 LAFAYETTE CIR STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4315
Practice Address - Country:US
Practice Address - Phone:925-946-9991
Practice Address - Fax:925-935-3123
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2019-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7178103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical