Provider Demographics
NPI:1801025333
Name:BRUBAKER, MEGAN ELAINE (MS, MFT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELAINE
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NORBRIDGE AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5700
Mailing Address - Country:US
Mailing Address - Phone:925-878-1867
Mailing Address - Fax:
Practice Address - Street 1:1700 NORBRIDGE AVE
Practice Address - Street 2:SUITE H
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5700
Practice Address - Country:US
Practice Address - Phone:925-878-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 50708106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist