MEDICARE: ELISABETH HOLLY BRITTELL 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	PSY27604	CA

General Provider Information

NPI Number	:	1629115357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISABETH HOLLY BRITTELL PSY.D.

Provider Business Mailing Address
First Line	:	1508 JETTY DR
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-4229
Country	:	US
Telephone Number	:	818-521-5863
Fax Number	:

Provider Business Practice Location Address
First Line	:	3554 ROUND BARN BLVD
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-0929
Country	:	US
Telephone Number	:	707-571-3778
Fax Number	:

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	01/03/2022

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