Provider Demographics
NPI:1124394671
Name:BRENIZER, SUSAN HARTMAN (MA, LMFT (LICENSED)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HARTMAN
Last Name:BRENIZER
Suffix:
Gender:F
Credentials:MA, LMFT (LICENSED
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:7000 E GENESEE ST LYNDON OFFICE PARK, BLDG. A
Mailing Address - Street 2:SECOND FLOOR (UPPER LEVEL)
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066
Mailing Address - Country:US
Mailing Address - Phone:315-446-9646
Mailing Address - Fax:315-637-6264
Practice Address - Street 1:7000 E GENESEE ST LYNDON OFFICE PARK, BLDG. A
Practice Address - Street 2:SECOND FLOOR (UPPER LEVEL)
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066
Practice Address - Country:US
Practice Address - Phone:315-446-9646
Practice Address - Fax:315-637-6264
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYSTATE#000-425106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist