MEDICARE: DR. BRENDA FAYE FAULKNER PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY21172	CA

General Provider Information

NPI Number	:	1245319763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENDA FAYE FAULKNER PSY.D

Provider Business Mailing Address
First Line	:	921 E COMPTON BLVD
Second Line	:	1 FLOOR
City	:	COMPTON
State	:	CA
Zip	:	90221-3303
Country	:	US
Telephone Number	:	310-668-6933
Fax Number	:	310-898-1607

Provider Business Practice Location Address
First Line	:	921 E. COMPTON AVE
Second Line	:	1ST FLOOR
City	:	COMPTON
State	:	CA
Zip	:	90221-2209
Country	:	US
Telephone Number	:	310-668-6933
Fax Number	:	310-898-1607

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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