Provider Demographics
NPI:1063278034
Name:DENNISON, BRIANNA DANIELLE
Entity type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:DANIELLE
Last Name:DENNISON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BRIANNA
Other - Middle Name:DANIELLE
Other - Last Name:BARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5901 AZTEC AVE APT 170
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-2399
Mailing Address - Country:US
Mailing Address - Phone:760-514-2440
Mailing Address - Fax:
Practice Address - Street 1:5901 AZTEC AVE APT 170
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-2399
Practice Address - Country:US
Practice Address - Phone:760-514-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst