| Doctor Name: | VIRGINIA BRENNER |
| NPI Number: | 1144682667 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. |
| License Number: | LEP652 |
| Business Practice Address: | 23 Escalle Ln 980 Magnolia Ave. Larkspur, CA - 949391216 |
| Business Phone Number: | 4159272767 |
| Business Fax Number: | 4154614626 |
| Mailing Address: | 23 Escalle Ln, LARKSPUR |
| State: | CA |
| Postal Code: | 949391216 |
| Phone Number: | 4159272767 |
| Fax Number: | 4154614626 |
| NPI Enumeration Date: | 03/23/2016 |
| NPI Last Update Date: | 03/23/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | LEP652 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |