Provider Demographics
NPI:1700879301
Name:BROTHERS, NANCY N (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:N
Last Name:BROTHERS
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 2435
Mailing Address - Street 2:
Mailing Address - City:IDYLLWILD
Mailing Address - State:CA
Mailing Address - Zip Code:92549-2435
Mailing Address - Country:US
Mailing Address - Phone:951-659-2207
Mailing Address - Fax:951-659-2246
Practice Address - Street 1:54295 VILLAGE CENTER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:IDYLLWILD
Practice Address - State:CA
Practice Address - Zip Code:92549-2435
Practice Address - Country:US
Practice Address - Phone:951-659-2207
Practice Address - Fax:951-659-2246
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12284103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR23980Medicare UPIN
CA0PL12284Medicare ID - Type UnspecifiedMEDICARE