Healthcare Provider Details

I. General information

NPI: 1134789886
Provider Name (Legal Business Name): KATHERINE LUCILLE BROSSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2019
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE., BUILDING 5, SUITE 6B
SAN FRANCISCO CA
94110-9411
US

IV. Provider business mailing address

1001 POTRERO AVE BLDG 5 SUITE 6B
SAN FRANCISCO CA
94110-3518
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-5270
  • Fax:
Mailing address:
  • Phone: 628-206-5270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number122646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: