Provider Demographics
NPI:1477607968
Name:HUGHEY, BRENT (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:HUGHEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7901 STONERIDGE DR
Mailing Address - Street 2:STE 110
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3677
Mailing Address - Country:US
Mailing Address - Phone:925-469-1989
Mailing Address - Fax:925-426-2328
Practice Address - Street 1:7901 STONERIDGE DR
Practice Address - Street 2:521
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3677
Practice Address - Country:US
Practice Address - Phone:925-469-1989
Practice Address - Fax:925-426-2328
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY137030103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY137030OtherSTATE LICENSE
CAPSY137030OtherSTATE LICENSE
CA0PL137030Medicare PIN