Provider Demographics
NPI:1083680821
Name:BRENNER, LISA ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:BRENNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 CLERMONT ST
Mailing Address - Street 2:116B
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3808
Mailing Address - Country:US
Mailing Address - Phone:303-399-8020
Mailing Address - Fax:303-393-5076
Practice Address - Street 1:1055 CLERMONT ST
Practice Address - Street 2:116B
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3808
Practice Address - Country:US
Practice Address - Phone:303-399-8020
Practice Address - Fax:303-393-5076
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2312103T00000X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation