Provider Demographics
NPI:1205271798
Name:BEHRENS, BEATRIZ (LCSW 121322)
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:BEHRENS
Suffix:
Gender:F
Credentials:LCSW 121322
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 N DUTTON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4668
Mailing Address - Country:US
Mailing Address - Phone:707-889-7901
Mailing Address - Fax:707-565-1110
Practice Address - Street 1:1360 N DUTTON AVE STE C
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4668
Practice Address - Country:US
Practice Address - Phone:707-889-7901
Practice Address - Fax:707-565-1110
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1213221041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical