Provider Demographics
NPI:1629193966
Name:GUTHRIE, BRYANNE MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:BRYANNE
Middle Name:MARIE
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRYANNE
Other - Middle Name:MARIE
Other - Last Name:O'LEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6123
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-0123
Mailing Address - Country:US
Mailing Address - Phone:310-413-1563
Mailing Address - Fax:
Practice Address - Street 1:1550 TREAT AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-5234
Practice Address - Country:US
Practice Address - Phone:415-641-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW644521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical