Provider Demographics
NPI:1114917093
Name:BRANNAN, JEAN K (LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:K
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 REEDSDALE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15233-2109
Mailing Address - Country:US
Mailing Address - Phone:412-323-8026
Mailing Address - Fax:412-323-4507
Practice Address - Street 1:330 9TH ST
Practice Address - Street 2:SOUTH 9TH STREET CENTER
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-2358
Practice Address - Country:US
Practice Address - Phone:412-488-4040
Practice Address - Fax:412-488-4932
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0131371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA550459OtherHIGHMARK
S96617Medicare UPIN
PA034258Medicare ID - Type Unspecified