Healthcare Provider Details

I. General information

NPI: 1790318293
Provider Name (Legal Business Name): DEBORAH BREWER INC LICENSED CLINICAL SOCIAL WORKER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 SANTA CRUZ AVE STE C
MENLO PARK CA
94025-4633
US

IV. Provider business mailing address

1700 WEBSTER ST
PALO ALTO CA
94301-3853
US

V. Phone/Fax

Practice location:
  • Phone: 650-223-1952
  • Fax:
Mailing address:
  • Phone: 650-223-1952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH ANNE BREWER
Title or Position: CEO
Credential: LCSW
Phone: 650-223-1952