Basic Information
| Provider Information | |||||||||
| NPI: | 1669565990 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUMM | ||||||||
| FirstName: | VIRDETTE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3534 | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939213534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316429400 | ||||||||
| FaxNumber: | 8316457906 | ||||||||
| Practice Location | |||||||||
| Address1: | 787 MUNRAS AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939403128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316429400 | ||||||||
| FaxNumber: | 8316457906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2006 | ||||||||
| LastUpdateDate: | 07/27/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | PSY15531 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
ID Information
| ID | Type | State | Issuer | Description | PSY155310 | 05 | CA | MEDICAID |