Healthcare Provider Details

I. General information

NPI: 1639333685
Provider Name (Legal Business Name): ERIC PAUL BRENMARK MHRS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 ROSIN CT STE 130
SACRAMENTO CA
95834-1647
US

IV. Provider business mailing address

3870 ROSIN CT STE 130
SACRAMENTO CA
95834-1647
US

V. Phone/Fax

Practice location:
  • Phone: 916-363-1553
  • Fax: 916-363-1638
Mailing address:
  • Phone: 916-363-1553
  • Fax: 916-363-1638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: