Healthcare Provider Details

I. General information

NPI: 1063998151
Provider Name (Legal Business Name): ADRIANNA GABRIELLA DE'SANTIAGO M.A., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 RAND AVE APT 209
OAKLAND CA
94610-2212
US

IV. Provider business mailing address

PO BOX 804
BERKELEY CA
94701-0804
US

V. Phone/Fax

Practice location:
  • Phone: 510-480-0938
  • Fax: 510-480-0948
Mailing address:
  • Phone: 510-480-0938
  • Fax: 510-480-0948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number147045
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: