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General NPI Number Information
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NPI Number | 1316391394
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Entity Type | Individual
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Provider Name | DEIDRE LAVRADOR LMFT
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Gender | Female
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 720 SUNRISE AVE STE 115D
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City | ROSEVILLE
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State | CA
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Zip | 95661-4509
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Country | US
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Telephone | 916-850-0147
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Fax | 916-772-8527
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Provider Business Mailing Address
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Address Line | 720 SUNRISE AVE STE 115D
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City | ROSEVILLE
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State | CA
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Zip | 95661-4509
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Country | US
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Telephone | 916-850-0147
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Fax | 916-772-8527
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 90272
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License Number State | CA
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