Provider Demographics
NPI:1386378867
Name:FOLEY, BRANGWYN URSULA
Entity type:Individual
Prefix:
First Name:BRANGWYN
Middle Name:URSULA
Last Name:FOLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 GARDEN CIR APT 20
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8525
Mailing Address - Country:US
Mailing Address - Phone:530-727-4002
Mailing Address - Fax:
Practice Address - Street 1:838 BEACH COURT
Practice Address - Street 2:
Practice Address - City:LOTUS
Practice Address - State:CA
Practice Address - Zip Code:95651
Practice Address - Country:US
Practice Address - Phone:530-626-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1445230921101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)