Healthcare Provider Details

I. General information

NPI: 1871723965
Provider Name (Legal Business Name): SERENA KAMDAR MAZZOLA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 CROW CANYON RD STE 205
SAN RAMON CA
94583-1639
US

IV. Provider business mailing address

4155 BLACKHAWK PLAZA CIR STE 101
DANVILLE CA
94506-4829
US

V. Phone/Fax

Practice location:
  • Phone: 925-360-0475
  • Fax:
Mailing address:
  • Phone: 925-683-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number142485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: