Provider Demographics
NPI:1770782484
Name:HANNAN, JOHN MATTHEW (PHD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MATTHEW
Last Name:HANNAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:HANNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1001 SNEATH LN
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2308
Mailing Address - Country:US
Mailing Address - Phone:650-616-6200
Mailing Address - Fax:650-616-6210
Practice Address - Street 1:1001 SNEATH LN
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2308
Practice Address - Country:US
Practice Address - Phone:650-616-6200
Practice Address - Fax:650-616-6210
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21493103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling