Provider Demographics
NPI:1578641098
Name:BRINDERSON, CHAD DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:DAVID
Last Name:BRINDERSON
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 1:2401 PCH HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2734
Mailing Address - Country:US
Mailing Address - Phone:310-291-0851
Mailing Address - Fax:
Practice Address - Street 1:2401 PACIFIC COAST HWY STE 103
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2734
Practice Address - Country:US
Practice Address - Phone:310-291-0851
Practice Address - Fax:310-782-3461
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15106103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent