Provider Demographics
NPI:1316410350
Name:MCDOWELL, BRENNEN MARQUES
Entity Type:Individual
Prefix:
First Name:BRENNEN
Middle Name:MARQUES
Last Name:MCDOWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SAN FELIPE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3033
Mailing Address - Country:US
Mailing Address - Phone:165-029-6302
Mailing Address - Fax:
Practice Address - Street 1:101 SNEATH LANE STE. 200
Practice Address - Street 2:200
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066
Practice Address - Country:US
Practice Address - Phone:510-268-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst