Provider Demographics
NPI:1326534751
Name:FAJARDO, BRITTANY ANNE
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ANNE
Last Name:FAJARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1093 60TH ST
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2332
Mailing Address - Country:US
Mailing Address - Phone:510-575-7305
Mailing Address - Fax:
Practice Address - Street 1:1093 60TH ST
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2332
Practice Address - Country:US
Practice Address - Phone:510-575-7305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst