Provider Demographics
NPI:1295089902
Name:BRENUM, ELIZABETH (MSW, ASW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BRENUM
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 FILLMORE ST
Mailing Address - Street 2:#204
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-5236
Mailing Address - Country:US
Mailing Address - Phone:415-685-9600
Mailing Address - Fax:
Practice Address - Street 1:1426 FILLMORE ST STE 204
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-4164
Practice Address - Country:US
Practice Address - Phone:510-333-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 33702101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor