Provider Demographics
NPI:1124737234
Name:HANNAN, JANARA
Entity type:Individual
Prefix:
First Name:JANARA
Middle Name:
Last Name:HANNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CONCAR DR STE 4-134
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2681
Mailing Address - Country:US
Mailing Address - Phone:650-931-6300
Mailing Address - Fax:
Practice Address - Street 1:400 CONCAR DR STE 4-134
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2681
Practice Address - Country:US
Practice Address - Phone:650-931-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2023-09-01
Deactivation Date:2023-08-21
Deactivation Code:
Reactivation Date:2023-08-31
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician