Provider Demographics
NPI:1255621272
Name:CASTRO-MCDANIEL, SHAUNA LIZA (LMFT)
Entity type:Individual
Prefix:MS
First Name:SHAUNA
Middle Name:LIZA
Last Name:CASTRO-MCDANIEL
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 1:1151 HARBOR BAY PKWY
Mailing Address - Street 2:SUITE 208 D
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-6540
Mailing Address - Country:US
Mailing Address - Phone:510-692-9822
Mailing Address - Fax:
Practice Address - Street 1:1151 HARBOR BAY PKWY
Practice Address - Street 2:SUITE 208 D
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94502-6540
Practice Address - Country:US
Practice Address - Phone:510-692-9822
Practice Address - Fax:877-991-7005
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA80444106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker