Provider Demographics
NPI:1770749384
Name:BROSNAN, JEFFREY W (LMFT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:W
Last Name:BROSNAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4994
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263
Mailing Address - Country:US
Mailing Address - Phone:310-733-9478
Mailing Address - Fax:
Practice Address - Street 1:2825 E TAHQUITZ CANYON WAY
Practice Address - Street 2:BLDG C
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6906
Practice Address - Country:US
Practice Address - Phone:310-733-9478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49984106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist