Provider Demographics
NPI:1477821544
Name:ALLISON BROENNIMANN, PH.D.
Entity Type:Organization
Organization Name:ALLISON BROENNIMANN, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROENNIMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:888-667-4828
Mailing Address - Street 1:PO BOX 2451
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-2451
Mailing Address - Country:US
Mailing Address - Phone:888-667-4828
Mailing Address - Fax:855-748-9025
Practice Address - Street 1:4200 18TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2470
Practice Address - Country:US
Practice Address - Phone:888-667-4828
Practice Address - Fax:855-748-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24463103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty