Provider Demographics
NPI:1609893353
Name:BROUGHTON, SINEAD PATRICIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:SINEAD
Middle Name:PATRICIA
Last Name:BROUGHTON
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 1:21 TAMAL VISTA BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1115
Mailing Address - Country:US
Mailing Address - Phone:415-806-6634
Mailing Address - Fax:
Practice Address - Street 1:21 TAMAL VISTA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1115
Practice Address - Country:US
Practice Address - Phone:415-806-6634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20277103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical