Provider Demographics
NPI:1750995544
Name:BRISEBOIS, CATHERINE (MSW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BRISEBOIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:BRISE
Other - Middle Name:CN
Other - Last Name:BRISEBOIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:2850 25TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4262
Mailing Address - Country:US
Mailing Address - Phone:760-450-6361
Mailing Address - Fax:
Practice Address - Street 1:2850 25TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4262
Practice Address - Country:US
Practice Address - Phone:760-450-6361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program