Provider Demographics
NPI:1558628461
Name:BROWN-NOLLEY, SANDRA (INTERN)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:BROWN-NOLLEY
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 POLK ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-6915
Mailing Address - Country:US
Mailing Address - Phone:415-487-3300
Mailing Address - Fax:510-487-3300
Practice Address - Street 1:1001 POLK ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6915
Practice Address - Country:US
Practice Address - Phone:415-487-3300
Practice Address - Fax:415-487-3300
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62854106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist