Healthcare Provider Details

I. General information

NPI: 1205271798
Provider Name (Legal Business Name): BEATRIZ BEHRENS LCSW 121322
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 N DUTTON AVE STE C
SANTA ROSA CA
95401-4668
US

IV. Provider business mailing address

1360 N DUTTON AVE STE C
SANTA ROSA CA
95401-4668
US

V. Phone/Fax

Practice location:
  • Phone: 707-889-7901
  • Fax: 707-565-1110
Mailing address:
  • Phone: 707-889-7901
  • Fax: 707-565-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number121322
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: