Healthcare Provider Details

I. General information

NPI: 1477250579
Provider Name (Legal Business Name): BRENNA CHRISTINE TAYLOR-FORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MILLER AVE
MILL VALLEY CA
94941-2844
US

IV. Provider business mailing address

PO BOX 307
MILL VALLEY CA
94942-0307
US

V. Phone/Fax

Practice location:
  • Phone: 415-413-7241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number80156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: