MEDICARE: ESTHER REBECCA BRASS PH.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	103T00000X	Psychologist	PSY5696	CA

General Provider Information

NPI Number	:	1548380595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTHER REBECCA BRASS PH.D.

Provider Business Mailing Address
First Line	:	1235 MARIN AVE
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-2042
Country	:	US
Telephone Number	:	510-524-0456
Fax Number	:	510-525-2403

Provider Business Practice Location Address
First Line	:	1235 MARIN AVE
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-2042
Country	:	US
Telephone Number	:	510-524-0456
Fax Number	:	510-525-2403

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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