Provider Demographics
NPI:1629306196
Name:VAN BREE, GLORIA LORRAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:LORRAINE
Last Name:VAN BREE
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 1:445 BURGESS DR
Mailing Address - Street 2:#150
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-3442
Mailing Address - Country:US
Mailing Address - Phone:650-964-7774
Mailing Address - Fax:650-657-9434
Practice Address - Street 1:445 BURGESS DR
Practice Address - Street 2:#150
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3442
Practice Address - Country:US
Practice Address - Phone:650-964-7774
Practice Address - Fax:650-657-9434
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-21
Last Update Date:2009-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10608101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)