Provider Demographics
NPI:1154962785
Name:BROSNAHAN, LEAH JEAN
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:JEAN
Last Name:BROSNAHAN
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 1:3466 ALANI DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1409
Mailing Address - Country:US
Mailing Address - Phone:608-234-0590
Mailing Address - Fax:
Practice Address - Street 1:3466 ALANI DR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1409
Practice Address - Country:US
Practice Address - Phone:608-234-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician