Provider Demographics
NPI:1972326858
Name:BRENDEL, ADDISON (EDS, NCSP, LEP)
Entity type:Individual
Prefix:MRS
First Name:ADDISON
Middle Name:
Last Name:BRENDEL
Suffix:
Gender:F
Credentials:EDS, NCSP, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5548 IDLEWILD AVE
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-1130
Mailing Address - Country:US
Mailing Address - Phone:916-218-8816
Mailing Address - Fax:
Practice Address - Street 1:800 MARYLIN AVE
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-6514
Practice Address - Country:US
Practice Address - Phone:925-606-4724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4300103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4300OtherBOARD OF BEHAVIORAL SCIENCES