Provider Demographics
NPI:1578281978
Name:FONAREV, BRENDA (MS COUNSELING)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:FONAREV
Suffix:
Gender:
Credentials:MS COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LOS CEDROS DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3764
Mailing Address - Country:US
Mailing Address - Phone:415-827-8112
Mailing Address - Fax:
Practice Address - Street 1:27 LOS CEDROS DR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-3764
Practice Address - Country:US
Practice Address - Phone:415-827-8112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152654106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist