Provider Demographics
NPI:1013957810
Name:FERM, BRENT RICHARD (PHD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:RICHARD
Last Name:FERM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:641 E BLITHEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1477
Mailing Address - Country:US
Mailing Address - Phone:415-383-0407
Mailing Address - Fax:415-383-3868
Practice Address - Street 1:150 MUIR RD
Practice Address - Street 2:MENTAL HEALTH
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4668
Practice Address - Country:US
Practice Address - Phone:925-372-2105
Practice Address - Fax:415-383-3868
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13371103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist