Provider Demographics
NPI:1558496836
Name:BROUNSTEIN, DALE A (PHD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:A
Last Name:BROUNSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8196 SW HALL BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6411
Mailing Address - Country:US
Mailing Address - Phone:503-639-2300
Mailing Address - Fax:503-968-1800
Practice Address - Street 1:8196 SW HALL BLVD STE 102A
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-4676
Practice Address - Country:US
Practice Address - Phone:503-639-2300
Practice Address - Fax:503-968-1800
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA466103T00000X
OR292103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4100374OtherAENTA
164986OtherVALUE OPTIONS
164986OtherVALUE OPTIONS