Provider Demographics
NPI:1396093340
Name:BRUNETTO, BENEDETTO GIUSEPPE FORREST (PSYD)
Entity type:Individual
Prefix:DR
First Name:BENEDETTO
Middle Name:GIUSEPPE FORREST
Last Name:BRUNETTO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:BEN
Other - Middle Name:GIUSEPPE FORREST
Other - Last Name:BRUNETTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1664 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5201
Mailing Address - Country:US
Mailing Address - Phone:619-579-8685
Mailing Address - Fax:
Practice Address - Street 1:451 RIVERVIEW PKWY
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-5829
Practice Address - Country:US
Practice Address - Phone:619-258-3089
Practice Address - Fax:619-258-3203
Is Sole Proprietor?:No
Enumeration Date:2012-08-23
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30812103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical