Provider Demographics
NPI:1609585330
Name:BARBOSA, BROCK (AMFT)
Entity type:Individual
Prefix:
First Name:BROCK
Middle Name:
Last Name:BARBOSA
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E CENTER ST STE 112-3221
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-7204
Mailing Address - Country:US
Mailing Address - Phone:747-254-6290
Mailing Address - Fax:
Practice Address - Street 1:201 E CENTER ST STE 112-3221
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-7204
Practice Address - Country:US
Practice Address - Phone:747-254-6290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT135969106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAMFT135969OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES