Provider Demographics
NPI:1467785725
Name:BALOGH, BRITTANY MERRAE (PHD)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MERRAE
Last Name:BALOGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:MERRAE
Other - Last Name:PAULUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:15899 LOS GATOS ALMADEN ROAD, SUITE 3
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032
Mailing Address - Country:US
Mailing Address - Phone:669-251-1067
Mailing Address - Fax:408-228-3919
Practice Address - Street 1:15899 LOS GATOS ALMADEN ROAD, SUITE 3
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032
Practice Address - Country:US
Practice Address - Phone:669-251-1067
Practice Address - Fax:408-228-3919
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 27139103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist