Healthcare Provider Details

I. General information

NPI: 1073274015
Provider Name (Legal Business Name): BRANDON CHIAPUZIO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 ASHBY AVE
BERKELEY CA
94705-2200
US

IV. Provider business mailing address

2615 ASHBY AVE
BERKELEY CA
94705-2200
US

V. Phone/Fax

Practice location:
  • Phone: 510-200-8867
  • Fax:
Mailing address:
  • Phone: 805-559-7881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: