MEDICARE: CATHERINE BRISEBOIS MSW

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	390200000X	Student in an Organized Health Care Education/Training Program
2	101Y00000X	Counselor		CA

General Provider Information

NPI Number	:	1750995544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE BRISEBOIS MSW

Provider Business Mailing Address
First Line	:	2850 25TH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-4262
Country	:	US
Telephone Number	:	760-450-6361
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 25TH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-4262
Country	:	US
Telephone Number	:	760-450-6361
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2020
Last Update Date	:	12/13/2021

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