Provider Demographics
NPI:1730241860
Name:BRIGHAM, ELIZABETH TESS (MA)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:TESS
Last Name:BRIGHAM
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 1:2914B LORINA ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1807
Mailing Address - Country:US
Mailing Address - Phone:510-981-8119
Mailing Address - Fax:
Practice Address - Street 1:1899 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3501
Practice Address - Country:US
Practice Address - Phone:415-934-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51518106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11297OtherMEDI-CAL NUMBER