Provider Demographics
NPI:1942689823
Name:CARRASCO, BRENDA (LCSW120062)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:LCSW120062
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:CARRASCO HARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW120062
Mailing Address - Street 1:1303 SAN CARLOS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2317
Mailing Address - Country:US
Mailing Address - Phone:650-740-1953
Mailing Address - Fax:
Practice Address - Street 1:1303 SAN CARLOS AVE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2317
Practice Address - Country:US
Practice Address - Phone:650-740-1953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-25
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 390200000X
CALCSW1200621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program