Provider Demographics
NPI:1679852214
Name:BREZNIK-YOUNG, BONNIE SUE
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:SUE
Last Name:BREZNIK-YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1511
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-0151
Mailing Address - Country:US
Mailing Address - Phone:925-583-5303
Mailing Address - Fax:
Practice Address - Street 1:1885 LUNDY AVE STE 223
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1888
Practice Address - Country:US
Practice Address - Phone:408-284-9086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-14
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health