Provider Demographics
NPI:1376690404
Name:BRENNER, GAIL F (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:F
Last Name:BRENNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90658
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93190-0658
Mailing Address - Country:US
Mailing Address - Phone:805-570-9765
Mailing Address - Fax:805-963-4922
Practice Address - Street 1:22 W MICHELTORENA ST
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-6522
Practice Address - Country:US
Practice Address - Phone:805-570-9765
Practice Address - Fax:805-963-4922
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12577103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY125770Medicaid
CAPSY125770Medicaid