Provider Demographics
NPI:1528159704
Name:BRENNER-LISS, DEBORAH (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:BRENNER-LISS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:BRENNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:3195 CALIFORNIA STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115
Mailing Address - Country:US
Mailing Address - Phone:415-771-3068
Mailing Address - Fax:
Practice Address - Street 1:3195 CALIFORNIA STREET
Practice Address - Street 2:SUITE E
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:415-771-3068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9452103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL94520Medicare ID - Type Unspecified