Provider Demographics
NPI:1124298559
Name:BRANSTETTER, REBECCA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANN
Last Name:BRANSTETTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:P.O. BOX 8683
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94662
Mailing Address - Country:US
Mailing Address - Phone:510-681-4303
Mailing Address - Fax:510-547-8790
Practice Address - Street 1:595 BUCKINGHAM WAY
Practice Address - Street 2:STE 532
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132
Practice Address - Country:US
Practice Address - Phone:510-681-4303
Practice Address - Fax:510-547-8790
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB32977103TC0700X
CALEP2864103TS0200X
CAPSY#22654103TC0700X
CALEP#2864103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool