Provider Demographics
NPI:1871665323
Name:SANDERS, BRIAN A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:A
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 CAMINO DIABLO
Mailing Address - Street 2:STE. 130
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3997
Mailing Address - Country:US
Mailing Address - Phone:925-210-7374
Mailing Address - Fax:
Practice Address - Street 1:2910 CAMINO DIABLO
Practice Address - Street 2:STE. 130
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-3997
Practice Address - Country:US
Practice Address - Phone:925-210-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21026103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical