=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508082298
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADRIANNE BLANCHE CASADABAN PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 09/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 LAFAYETTE CIR STE 100
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94549-4315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-946-9991
-----------------------------------------------------
Fax | 925-935-3123
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3473 SHANGRI LA RD
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94549-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-946-9991
-----------------------------------------------------
Fax | 925-935-3123
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY7178
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------