Provider Demographics
NPI:1669565990
Name:BRUMM, VIRDETTE L (PHD)
Entity type:Individual
Prefix:DR
First Name:VIRDETTE
Middle Name:L
Last Name:BRUMM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3534
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93921-3534
Mailing Address - Country:US
Mailing Address - Phone:831-642-9400
Mailing Address - Fax:831-645-7906
Practice Address - Street 1:787 MUNRAS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3128
Practice Address - Country:US
Practice Address - Phone:831-642-9400
Practice Address - Fax:831-645-7906
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15531103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY155310Medicaid
CACP15531Medicare ID - Type Unspecified