Provider Demographics
NPI:1578220901
Name:BRYANT, JENEE MIRANDA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENEE
Middle Name:MIRANDA
Last Name:BRYANT
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 1:561 BURNETT AVENUE
Mailing Address - Street 2:#1
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131
Mailing Address - Country:US
Mailing Address - Phone:225-445-1761
Mailing Address - Fax:
Practice Address - Street 1:561 BURNETT AVENUE
Practice Address - Street 2:#1
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131
Practice Address - Country:US
Practice Address - Phone:225-445-1761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW86757101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health