Provider Demographics
NPI:1225152135
Name:BRENNER, LYNDA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:
Last Name:BRENNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 ROCKLEDGE RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12529-6226
Mailing Address - Country:US
Mailing Address - Phone:518-325-9524
Mailing Address - Fax:
Practice Address - Street 1:92 ROCKLEDGE RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NY
Practice Address - Zip Code:12529-6226
Practice Address - Country:US
Practice Address - Phone:518-325-9524
Practice Address - Fax:518-325-7364
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO20519-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161550Medicare UPIN
NY25795000Medicare UPIN
NY784792Medicare UPIN
NYN9H201Medicare ID - Type Unspecified
NY174948Medicare UPIN