Provider Demographics
NPI:1679875116
Name:BECCIO, BRANDON MARC (MFT)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:MARC
Last Name:BECCIO
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:MR
Other - First Name:BRANDON
Other - Middle Name:MARC
Other - Last Name:BECCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:847 SHADY OAK DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-2781
Mailing Address - Country:US
Mailing Address - Phone:707-849-8138
Mailing Address - Fax:
Practice Address - Street 1:401 BICENTENNIAL WAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2149
Practice Address - Country:US
Practice Address - Phone:707-571-3764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80836106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist