Provider Demographics
NPI:1023250453
Name:MILLER BRUNETTO, HEIDI LYNNE (PSYD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNNE
Last Name:MILLER BRUNETTO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N DATE ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3413
Mailing Address - Country:US
Mailing Address - Phone:760-737-6960
Mailing Address - Fax:760-741-2782
Practice Address - Street 1:855 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3819
Practice Address - Country:US
Practice Address - Phone:619-440-2751
Practice Address - Fax:858-633-4692
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26809103T00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health