Provider Demographics
NPI:1518389030
Name:BRANNIES GARCIA, JENNIFER LEE (BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:BRANNIES GARCIA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 EL CAMINO REAL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4216
Mailing Address - Country:US
Mailing Address - Phone:805-813-7586
Mailing Address - Fax:805-468-6031
Practice Address - Street 1:6955 EL CAMINO REAL
Practice Address - Street 2:SUITE 210
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4216
Practice Address - Country:US
Practice Address - Phone:805-813-7586
Practice Address - Fax:805-468-6031
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11313599103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst