Provider Demographics
NPI:1700935160
Name:BROTHERS, CLIFFORD MICHAEL (PHD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:MICHAEL
Last Name:BROTHERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4079 GLENWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066
Mailing Address - Country:US
Mailing Address - Phone:408-271-8558
Mailing Address - Fax:408-248-8250
Practice Address - Street 1:1101 S WINCHESTER BLVD
Practice Address - Street 2:BLDG O SUITE 284
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-271-8558
Practice Address - Fax:408-248-8260
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7003103TC0700X
CAMFT12129106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ24909ZMedicare ID - Type Unspecified
00PL70030Medicare UPIN