Healthcare Provider Details

I. General information

NPI: 1740720796
Provider Name (Legal Business Name): BRIANNA DANAE DICKELY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 SOQUEL AVE
SANTA CRUZ CA
95062-2301
US

IV. Provider business mailing address

UNITY CARE GROUP 4428 THISTLE DR
SAN JOSE CA
95136
US

V. Phone/Fax

Practice location:
  • Phone: 831-426-7322
  • Fax:
Mailing address:
  • Phone: 408-445-1548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: