Provider Demographics
NPI:1366772147
Name:THOMPSON, BRIAN FLETCHER (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:FLETCHER
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:FLETCHER
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:80 GREAT OAKS BLVD
Mailing Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS - SAN JOSE CLINIC
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119
Mailing Address - Country:US
Mailing Address - Phone:408-363-3000
Mailing Address - Fax:408-363-3046
Practice Address - Street 1:80 GREAT OAKS BLVD
Practice Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS - SAN JOSE CLINIC
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119
Practice Address - Country:US
Practice Address - Phone:408-363-3000
Practice Address - Fax:408-363-3046
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23142103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical