Provider Demographics
NPI:1932423100
Name:FISHLEDER, BRENDA L (LCSW, BCD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:FISHLEDER
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 TAMALPAIS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1558
Mailing Address - Country:US
Mailing Address - Phone:415-453-4236
Mailing Address - Fax:
Practice Address - Street 1:520 TAMALPAIS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1558
Practice Address - Country:US
Practice Address - Phone:415-453-4236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS110171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical