MEDICARE: BRAMBLE LANE PSYCHOLOGY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1417788043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAMBLE LANE PSYCHOLOGY, PC

Provider Business Mailing Address
First Line	:	2021 FILLMORE ST # 2148
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 UNION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4406
Country	:	US
Telephone Number	:	415-742-2225
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	CALEB BIRKHOFF
Credential	:	LMFT
Telephone Number	:	415-990-1452

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	06/02/2026

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