Provider Demographics
NPI:1043624893
Name:ZARATE, BRENDA
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:ZARATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 E LOCUST AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2928
Mailing Address - Country:US
Mailing Address - Phone:559-394-7860
Mailing Address - Fax:
Practice Address - Street 1:575 E LOCUST AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2928
Practice Address - Country:US
Practice Address - Phone:559-394-7860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 85098106H00000X
CA106540106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist