Provider Demographics
NPI:1629188917
Name:BRONSTEIN, DEBRA A (MFT)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:A
Last Name:BRONSTEIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5914 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2216
Mailing Address - Country:US
Mailing Address - Phone:510-464-1088
Mailing Address - Fax:
Practice Address - Street 1:20200 REDWOOD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4312
Practice Address - Country:US
Practice Address - Phone:510-464-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25358106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist