Provider Demographics
NPI:1487879169
Name:BRISCOE, MARTI J (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARTI
Middle Name:J
Last Name:BRISCOE
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:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94914-0621
Mailing Address - Country:US
Mailing Address - Phone:415-721-9992
Mailing Address - Fax:415-389-1073
Practice Address - Street 1:203 E BLITHEDALE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2046
Practice Address - Country:US
Practice Address - Phone:415-721-9992
Practice Address - Fax:415-389-1073
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical