Healthcare Provider Details

I. General information

NPI: 1063580439
Provider Name (Legal Business Name): LAURENCE BRENNER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 10TH AVE
SAN FRANCISCO CA
94122-2304
US

IV. Provider business mailing address

366 ROOSEVELT WAY
SAN FRANCISCO CA
94114-1434
US

V. Phone/Fax

Practice location:
  • Phone: 415-564-2310
  • Fax: 415-564-2313
Mailing address:
  • Phone: 415-861-4788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: