Provider Demographics
NPI:1194337576
Name:BRANNON, MAUREEN LUCILLE
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:LUCILLE
Last Name:BRANNON
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 1:613 E K ST
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3508
Mailing Address - Country:US
Mailing Address - Phone:707-704-7967
Mailing Address - Fax:
Practice Address - Street 1:1901 CHURCH LN
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3707
Practice Address - Country:US
Practice Address - Phone:510-236-3139
Practice Address - Fax:510-236-3200
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)