Provider Demographics
NPI:1245319763
Name:FAULKNER, BRENDA FAYE (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:FAYE
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:921 E COMPTON BLVD
Mailing Address - Street 2:1 FLOOR
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-3303
Mailing Address - Country:US
Mailing Address - Phone:310-668-6933
Mailing Address - Fax:310-898-1607
Practice Address - Street 1:921 E. COMPTON AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-2209
Practice Address - Country:US
Practice Address - Phone:310-668-6933
Practice Address - Fax:310-898-1607
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21172103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical