Provider Demographics
NPI:1104223155
Name:BRENNAN, SUZANNE MARIE (PHD RN)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MARIE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:PHD RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6535
Mailing Address - Country:US
Mailing Address - Phone:215-731-1707
Mailing Address - Fax:
Practice Address - Street 1:2130 PINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6535
Practice Address - Country:US
Practice Address - Phone:215-731-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
PARN-255881-L364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult