Provider Demographics
NPI:1427366210
Name:BROENNIMANN, ALLISON L (PHD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:L
Last Name:BROENNIMANN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2451
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-2451
Mailing Address - Country:US
Mailing Address - Phone:888-667-4828
Mailing Address - Fax:
Practice Address - Street 1:1939 DIVISADERO ST
Practice Address - Street 2:SUITE 1-C
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2507
Practice Address - Country:US
Practice Address - Phone:888-667-4828
Practice Address - Fax:855-748-9025
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY24463OtherCALIFORNIA BOARD OF PSYCHOLOGY