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General NPI Number Information
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NPI Number | 1538152467
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Entity Type | Individual
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Provider Name | BRIAN BROSNAN LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/25/2005
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 13157 RIVERSIDE DR APT 103
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2147
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Country | US
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Telephone | 910-233-6150
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Fax |
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Provider Business Mailing Address
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Address Line | 13157 RIVERSIDE DR APT 103
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2147
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Country | US
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Telephone | 910-233-6150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C004936
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW112491
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License Number State | CA
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