Provider Demographics
NPI:1326103888
Name:BRENNAN, TERRENCE P (PSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:P
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E ELIZABETH AVE
Mailing Address - Street 2:SUITE 301A
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6518
Mailing Address - Country:US
Mailing Address - Phone:610-974-8500
Mailing Address - Fax:610-974-9337
Practice Address - Street 1:65 E ELIZABETH AVE
Practice Address - Street 2:SUITE 301A
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6518
Practice Address - Country:US
Practice Address - Phone:610-974-8500
Practice Address - Fax:610-974-9337
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007002L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018848220003Medicaid