Provider Demographics
NPI:1477569465
Name:BRANNAN, JUDY FAYE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:JUDY
Middle Name:FAYE
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 WINDING WAY STE 111
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-4427
Mailing Address - Country:US
Mailing Address - Phone:916-628-8794
Mailing Address - Fax:
Practice Address - Street 1:4144 WINDING WAY STE 111
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4427
Practice Address - Country:US
Practice Address - Phone:916-628-8794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 243031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical