Provider Demographics
NPI:1205198900
Name:BRUNETTE, HEIDI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:BRUNETTE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1852
Mailing Address - Country:US
Mailing Address - Phone:415-721-0902
Mailing Address - Fax:415-721-2451
Practice Address - Street 1:1526 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1852
Practice Address - Country:US
Practice Address - Phone:415-721-0902
Practice Address - Fax:415-721-2451
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-09
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19234103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical