Provider Demographics
NPI:1144672718
Name:SORIA, BRENNA MARIE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:MARIE
Last Name:SORIA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:MARIE
Other - Last Name:WYCKOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-1309
Mailing Address - Country:US
Mailing Address - Phone:619-565-0384
Mailing Address - Fax:
Practice Address - Street 1:430 F ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3711
Practice Address - Country:US
Practice Address - Phone:619-420-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129247106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist