Provider Demographics
NPI:1831315811
Name:BRUNNER, PATRICIA DALEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:DALEY
Last Name:BRUNNER
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 1:2412 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7788
Mailing Address - Country:US
Mailing Address - Phone:916-678-0798
Mailing Address - Fax:916-772-2442
Practice Address - Street 1:2412 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7788
Practice Address - Country:US
Practice Address - Phone:916-678-0798
Practice Address - Fax:916-772-2442
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9737103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68-0346835OtherTAX ID NUMBER