Provider Demographics
NPI:1629288840
Name:BIRONDO, MICAYLA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MICAYLA
Middle Name:
Last Name:BIRONDO
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 1:2930 SHATTUCK AVE
Mailing Address - Street 2:SUITE 200-21
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1883
Mailing Address - Country:US
Mailing Address - Phone:510-501-3135
Mailing Address - Fax:
Practice Address - Street 1:2930 SHATTUCK AVE
Practice Address - Street 2:SUITE 200-21
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1883
Practice Address - Country:US
Practice Address - Phone:510-501-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46197106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist