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General NPI Number Information
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NPI Number | 1487879169
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Entity Type | Individual
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Provider Name | MARTI J BRISCOE PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 203 E BLITHEDALE AVE SUITE A
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City | MILL VALLEY
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State | CA
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Zip | 94941-2046
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Country | US
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Telephone | 415-721-9992
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Fax | 415-389-1073
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Provider Business Mailing Address
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Address Line | PO BOX 621
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City | KENTFIELD
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State | CA
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Zip | 94914-0621
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Country | US
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Telephone | 415-721-9992
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Fax | 415-389-1073
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 19101
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License Number State | CA
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