Healthcare Provider Details

I. General information

NPI: 1124298559
Provider Name (Legal Business Name): REBECCA ANN BRANSTETTER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA ANN BELL PH.D.

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 BUCKINGHAM WAY STE 532
SAN FRANCISCO CA
94132
US

IV. Provider business mailing address

P.O. BOX 8683
EMERYVILLE CA
94662
US

V. Phone/Fax

Practice location:
  • Phone: 510-681-4303
  • Fax: 510-547-8790
Mailing address:
  • Phone: 510-681-4303
  • Fax: 510-547-8790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB32977
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLEP2864
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY#22654
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLEP#2864
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: