Healthcare Provider Details

I. General information

NPI: 1639215643
Provider Name (Legal Business Name): BENBRUCE A. KANNE M.F.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11740 DUBLIN BLVD SUITE 206
DUBLIN CA
94568-2823
US

IV. Provider business mailing address

11740 DUBLIN BLVD SUITE 206
DUBLIN CA
94568-2823
US

V. Phone/Fax

Practice location:
  • Phone: 510-525-0505
  • Fax: 925-828-8238
Mailing address:
  • Phone: 510-525-0505
  • Fax: 925-828-8238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMH18947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: