Provider Demographics
NPI:1689864704
Name:BRANNOCK, JOANN CHERAMI (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:CHERAMI
Last Name:BRANNOCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:CHERAMI
Other - Last Name:SACHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 N POMONA AV
Mailing Address - Street 2:#1
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1927
Mailing Address - Country:US
Mailing Address - Phone:714-773-5006
Mailing Address - Fax:714-773-5386
Practice Address - Street 1:321 N POMONA AV
Practice Address - Street 2:#1
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1927
Practice Address - Country:US
Practice Address - Phone:714-773-5006
Practice Address - Fax:714-773-5386
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13602103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
218335OtherMHN
CAPSY13602Medicaid
218335OtherMHN