Provider Demographics
NPI:1639215643
Name:KANNE, BENBRUCE A (MFT)
Entity Type:Individual
Prefix:MR
First Name:BENBRUCE
Middle Name:A
Last Name:KANNE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11740 DUBLIN BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2823
Mailing Address - Country:US
Mailing Address - Phone:510-525-0505
Mailing Address - Fax:925-828-8238
Practice Address - Street 1:11740 DUBLIN BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2823
Practice Address - Country:US
Practice Address - Phone:510-525-0505
Practice Address - Fax:925-828-8238
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMH18947106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist