Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY11366 | CA |
NPI | 1003478405 |
---|---|
Provider Name | Dr. Melissa Berrenge-Browde |
First Address | Capitola, CA 95010-2102 |
Second Address | Capitola, CA 95010-2102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2019 |
Last Update Date | 05/07/2019 |