Healthcare Provider Details

I. General information

NPI: 1518153659
Provider Name (Legal Business Name): VANESSA C DE BRER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 FRANKLIN STREET
SAN FRANCISCO CA
94109-4523
US

IV. Provider business mailing address

1500 FRANKLIN STREET
SAN FRANCISCO CA
94109-4523
US

V. Phone/Fax

Practice location:
  • Phone: 415-474-7310
  • Fax:
Mailing address:
  • Phone: 415-474-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number26759
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: