Healthcare Provider Details

I. General information

NPI: 1487879169
Provider Name (Legal Business Name): MARTI J BRISCOE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E BLITHEDALE AVE SUITE A
MILL VALLEY CA
94941-2046
US

IV. Provider business mailing address

PO BOX 621
KENTFIELD CA
94914-0621
US

V. Phone/Fax

Practice location:
  • Phone: 415-721-9992
  • Fax: 415-389-1073
Mailing address:
  • Phone: 415-721-9992
  • Fax: 415-389-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: