Healthcare Provider Details

I. General information

NPI: 1295278513
Provider Name (Legal Business Name): JENNIFER BREUNIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 POMONA AVE
EL CERRITO CA
94530-4134
US

IV. Provider business mailing address

1061 53RD ST
OAKLAND CA
94608-3005
US

V. Phone/Fax

Practice location:
  • Phone: 510-213-2373
  • Fax:
Mailing address:
  • Phone: 510-273-4700
  • Fax: 510-530-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: