Provider Demographics
NPI:1700694924
Name:BRETON, LAURIE ANN (PPS)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ANN
Last Name:BRETON
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:CLARQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PPS
Mailing Address - Street 1:3434 MARTEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-1300
Mailing Address - Country:US
Mailing Address - Phone:408-223-3740
Mailing Address - Fax:
Practice Address - Street 1:3434 MARTEN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-1300
Practice Address - Country:US
Practice Address - Phone:408-223-3740
Practice Address - Fax:408-223-3742
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool