Provider Demographics
NPI:1669537205
Name:MCGOWAN SASS, BRENDA KATHLEEN (PHD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:KATHLEEN
Last Name:MCGOWAN SASS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W MAIN AVE
Mailing Address - Street 2:SUITE 11A
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037
Mailing Address - Country:US
Mailing Address - Phone:408-779-2700
Mailing Address - Fax:408-778-9588
Practice Address - Street 1:60 W MAIN AVE
Practice Address - Street 2:SUITE 11A
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037
Practice Address - Country:US
Practice Address - Phone:408-779-2700
Practice Address - Fax:408-778-9588
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPL6008103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00PL60080Medicare ID - Type Unspecified