Provider Demographics
NPI:1780716324
Name:MARQUEZ, ADRAIN BERNARDO (LMFT, MS)
Entity type:Individual
Prefix:MR
First Name:ADRAIN
Middle Name:BERNARDO
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:LMFT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1123
Mailing Address - Country:US
Mailing Address - Phone:559-549-6697
Mailing Address - Fax:559-354-0160
Practice Address - Street 1:2934 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1123
Practice Address - Country:US
Practice Address - Phone:559-549-6697
Practice Address - Fax:559-354-0160
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46686106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 46686OtherBOARD OF BEHAVIORAL SCIENCES