Healthcare Provider Details

I. General information

NPI: 1497663355
Provider Name (Legal Business Name): MARY BRIDEN BECERRA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N CLEMENTINE ST
OCEANSIDE CA
92054-2806
US

IV. Provider business mailing address

810 BROOKTREE LN APT 186
VISTA CA
92081-8676
US

V. Phone/Fax

Practice location:
  • Phone: 760-231-1170
  • Fax:
Mailing address:
  • Phone: 909-418-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: