Healthcare Provider Details

I. General information

NPI: 1740613033
Provider Name (Legal Business Name): CLARA BRANDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4026 PIEDMONT AVE
OAKLAND CA
94611-5209
US

IV. Provider business mailing address

3626 BALBOA ST
SAN FRANCISCO CA
94121-2604
US

V. Phone/Fax

Practice location:
  • Phone: 415-685-0488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number30385
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: