Provider Demographics
NPI:1225186646
Name:MS BRENNER CLIN PSYCH PC
Entity Type:Organization
Organization Name:MS BRENNER CLIN PSYCH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECTY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:212-873-6881
Mailing Address - Street 1:255 W 88 ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-873-9440
Mailing Address - Fax:212-877-9709
Practice Address - Street 1:255 W 88 ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-873-9440
Practice Address - Fax:212-877-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty