Provider Demographics
NPI:1295172633
Name:MEO, BREANNA (BCABA)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:MEO
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6960 DESTINY DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2993
Mailing Address - Country:US
Mailing Address - Phone:916-415-0119
Mailing Address - Fax:916-415-0120
Practice Address - Street 1:6960 DESTINY DR
Practice Address - Street 2:SUITE 112
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2993
Practice Address - Country:US
Practice Address - Phone:916-415-0119
Practice Address - Fax:916-415-0120
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst