Provider Demographics
NPI:1659880052
Name:BREWER, JASON DWAYNE
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DWAYNE
Last Name:BREWER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S B ST
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-4245
Mailing Address - Country:US
Mailing Address - Phone:650-579-7881
Mailing Address - Fax:650-579-2640
Practice Address - Street 1:720 S B ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4245
Practice Address - Country:US
Practice Address - Phone:650-579-7881
Practice Address - Fax:650-579-2640
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)