Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY13371 | CA |
Y | 103T00000X | Psychologist | PSY13371 | CA |
NPI | 1013957810 |
---|---|
Provider Name | Brent Richard Ferm |
First Address | Mill Valley, CA 94941-1477 |
Second Address | Martinez, CA 94553-4668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 08/07/2007 |