Healthcare Provider Details

I. General information

NPI: 1023822582
Provider Name (Legal Business Name): BRANDEN CONAN RENFRO ASW, LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 WILLOW RD BLDG 347
MENLO PARK CA
94025-2539
US

IV. Provider business mailing address

795 WILLOW RD BLDG 347
MENLO PARK CA
94025-2539
US

V. Phone/Fax

Practice location:
  • Phone: 650-460-9641
  • Fax:
Mailing address:
  • Phone: 650-460-9641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: