Provider Demographics
NPI:1184212581
Name:BRILEY, NAOMI
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:BRILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 TELEGRAPH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2072
Mailing Address - Country:US
Mailing Address - Phone:510-402-3945
Mailing Address - Fax:
Practice Address - Street 1:3021 TELEGRAPH AVE STE C
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2072
Practice Address - Country:US
Practice Address - Phone:510-402-3945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-02
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146205106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist