MEDICARE: DEVON D'AVANZO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	AMFT110602	CA
2	106S00000X	Behavior Technician	RBT-17-32057
3	106H00000X	Marriage & Family Therapist	LMFT151638	CA

General Provider Information

NPI Number	:	1497257349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVON D'AVANZO

Provider Business Mailing Address
First Line	:	13925 SAN PABLO AVE STE 208
Second Line	:
City	:	SAN PABLO
State	:	CA
Zip	:	94806-3676
Country	:	US
Telephone Number	:	415-456-7724
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 MARTIN LUTHER KING JR WAY
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-1412
Country	:	US
Telephone Number	:	415-617-9806
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	01/23/2025

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Directions to “ DEVON D'AVANZO ” Practice Location

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