Provider Demographics
NPI:1366936643
Name:BRANNAN, SEAN T (LMFT)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:T
Last Name:BRANNAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 CAMINO DEL RIO S STE 160
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3617
Mailing Address - Country:US
Mailing Address - Phone:619-865-6210
Mailing Address - Fax:
Practice Address - Street 1:2333 CAMINO DEL RIO S STE 160
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3617
Practice Address - Country:US
Practice Address - Phone:619-865-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106207106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist