=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730818725
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERI LURLENE BRAUDRICK-DOGINS SCHOOL PSYCHOLOGIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2022
-----------------------------------------------------
Last Update Date | 06/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 WINCHESTER CIR APT B309
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-1859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-331-3217
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 WINCHESTER CIR APT B309
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-1859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-331-3217
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TB0200X
-----------------------------------------------------
Taxonomy Name | Cognitive & Behavioral Psychologist
-----------------------------------------------------
License Number | 0824
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------