Healthcare Provider Details

I. General information

NPI: 1669811758
Provider Name (Legal Business Name): ERIN BREWBAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3164 CONDO CT
SANTA ROSA CA
95403-2557
US

IV. Provider business mailing address

228 BEACH PARK BLVD
FOSTER CITY CA
94404-2710
US

V. Phone/Fax

Practice location:
  • Phone: 707-360-1511
  • Fax:
Mailing address:
  • Phone: 650-759-4736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number35811
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number35811
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: