MEDICARE: DR. CHAD DAVID BRINDERSON 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	103TC2200X	Clinical Child & Adolescent Psychologist	15106	CA

General Provider Information

NPI Number	:	1578641098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD DAVID BRINDERSON PH.D.

Provider Business Mailing Address
First Line	:	2401 PCH HWY STE 103
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2734
Country	:	US
Telephone Number	:	310-291-0851
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 PACIFIC COAST HWY STE 103
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2734
Country	:	US
Telephone Number	:	310-291-0851
Fax Number	:	310-782-3461

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/15/2021

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