Provider Demographics
NPI:1801088786
Name:BRONTE, JACELYN (PHD)
Entity type:Individual
Prefix:DR
First Name:JACELYN
Middle Name:
Last Name:BRONTE
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 1:582 MARKET ST STE 801
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-5309
Mailing Address - Country:US
Mailing Address - Phone:415-763-5294
Mailing Address - Fax:510-433-0552
Practice Address - Street 1:582 MARKET ST STE 801
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-5309
Practice Address - Country:US
Practice Address - Phone:415-763-5294
Practice Address - Fax:510-433-0552
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23073103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical