Provider Demographics
NPI:1982705638
Name:SICKENIUS, BRAD (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:SICKENIUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:BRADLEY
Other - Middle Name:F
Other - Last Name:SICKENIUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2424 DWIGHT WAY STE 8
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2365
Mailing Address - Country:US
Mailing Address - Phone:510-435-6600
Mailing Address - Fax:510-588-4444
Practice Address - Street 1:2424 DWIGHT WAY STE 8
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2365
Practice Address - Country:US
Practice Address - Phone:510-435-6600
Practice Address - Fax:510-588-4444
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16336103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical