Provider Demographics
NPI:1043754187
Name:BRUBAKER, KATHRYN (BS, MS, MFT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:BS, MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1718
Mailing Address - Country:US
Mailing Address - Phone:818-807-5496
Mailing Address - Fax:
Practice Address - Street 1:144 CENTER ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1718
Practice Address - Country:US
Practice Address - Phone:818-807-5496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95082106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist