Provider Demographics
NPI:1386917730
Name:BREWER, HEATHER (MA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 30TH ST
Mailing Address - Street 2:SUITE 217
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3063
Mailing Address - Country:US
Mailing Address - Phone:323-319-6118
Mailing Address - Fax:
Practice Address - Street 1:2665 30TH ST
Practice Address - Street 2:SUITE 217
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3063
Practice Address - Country:US
Practice Address - Phone:323-319-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF65639106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist