Provider Demographics
NPI:1154859213
Name:DENBROEDER, MARK DENNIS (PHD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DENNIS
Last Name:DENBROEDER
Suffix:
Gender:M
Credentials:PHD
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Other - First Name:
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Mailing Address - Street 1:5776 STONERIDGE MALL ROAD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588
Mailing Address - Country:US
Mailing Address - Phone:925-734-8772
Mailing Address - Fax:925-467-1497
Practice Address - Street 1:5776 STONERIDGE MALL ROAD
Practice Address - Street 2:SUITE 140
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588
Practice Address - Country:US
Practice Address - Phone:925-734-8772
Practice Address - Fax:925-467-1497
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY10071103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist