Provider Demographics
NPI:1255787701
Name:ALAN R. BREEN, PHD, PLLC
Entity type:Organization
Organization Name:ALAN R. BREEN, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BREEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-860-0860
Mailing Address - Street 1:411 12TH AVE
Mailing Address - Street 2:STE 305
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122
Mailing Address - Country:US
Mailing Address - Phone:206-860-0860
Mailing Address - Fax:206-892-9785
Practice Address - Street 1:411 12TH AVE
Practice Address - Street 2:STE 305
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122
Practice Address - Country:US
Practice Address - Phone:206-860-0860
Practice Address - Fax:206-892-9785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA882103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty