Provider Demographics
NPI:1598991952
Name:COFFINO, BRIANNA S (PHD)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:S
Last Name:COFFINO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:415-942-4870
Mailing Address - Fax:415-492-4871
Practice Address - Street 1:100 ROWLAND WAY STE 205
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5041
Practice Address - Country:US
Practice Address - Phone:415-492-4870
Practice Address - Fax:415-492-4871
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY25256OtherSTATE MEDICAL LICENSE