Basic Information
| Provider Information | |||||||||
| NPI: | 1811023187 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUTON | ||||||||
| FirstName: | NOELLE | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 ALAMEDA DE LAS PULGAS | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944031222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503728596 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1950 ALAMEDA DE LAS PULGAS | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944031222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503728596 | ||||||||
| FaxNumber: | 6503417389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 03/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC39841 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | LMFT39841 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.