Sean P Brannon, PH.D., ABN
Individual provider Active NPI Clinical Psychologist · Patton, CA
NPI 1114178985 · NPPES record last updated May 5, 2015
Key facts
- NPI
- 1114178985
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 21995 (CA)
- Practice address
- 3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369 - Phone
- (909) 425-7679
- Fax
- (909) 425-6635
- NPI assigned
- Oct 9, 2008
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY21995 | CA | MD | Clinical Neuropsychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PSY21995 | CA | |
| Forensic Psychologist | 103TF0200X | PSY21995 | CA | |
| Clinical Psychologist | 103TC0700X | 21995 | CA | Yes |
Addresses
Primary practice location
3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369
Mailing address
3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369
Phone (909) 425-7679
Other providers in Patton, CA
- Marla D Berry
- Mina Beshara
- Nancy Ann Blacketer
- Andrew C Blaine
- Matthew Bonn
- Kim Lynette Braxton
- William Gordon Britt III
- Robert Edward Brodie
- Felicia Ann Brown
- Hong (Rose) Bui
All providers in Patton, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.