Provider Demographics
NPI:1487778049
Name:MIDDLEBROOK, MARLEY MAE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARLEY
Middle Name:MAE
Last Name:MIDDLEBROOK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 TICE VALLEY BLVD # 3221
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-2203
Mailing Address - Country:US
Mailing Address - Phone:925-352-1038
Mailing Address - Fax:949-757-2543
Practice Address - Street 1:1844 SAN MIGUEL DR STE 311
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4963
Practice Address - Country:US
Practice Address - Phone:925-352-1038
Practice Address - Fax:949-757-2543
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22606103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 22606OtherLICENSED PSYCHOLOGIST
CACK769AMedicare PIN