Provider Demographics
NPI:1033515309
Name:BRENNAN, ELIZABETH MARGARET (LMSW, D-PC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARGARET
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LMSW, D-PC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARGARET
Other - Last Name:BROUWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW, D-PC
Mailing Address - Street 1:677 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:269-467-1000
Mailing Address - Fax:269-467-3072
Practice Address - Street 1:677 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MI
Practice Address - Zip Code:49032
Practice Address - Country:US
Practice Address - Phone:269-467-1000
Practice Address - Fax:269-467-3072
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI104100000X, 1041C0700X
MI68011108051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker