1477821544 NPI number — ALLISON BROENNIMANN, PH.D.

Table of content: (NPI 1477821544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477821544 NPI number — ALLISON BROENNIMANN, PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLISON BROENNIMANN, PH.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477821544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2451
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVATO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94948-2451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-667-4828
Provider Business Mailing Address Fax Number:
855-748-9025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4200 18TH ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94114-2470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-667-4828
Provider Business Practice Location Address Fax Number:
855-748-9025
Provider Enumeration Date:
12/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BROENNIMANN
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
888-667-4828

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  24463 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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