Provider Demographics
NPI:1326425273
Name:BRENON, KASEY (LMHC)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:BRENON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 WHITETAIL CIR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-4157
Mailing Address - Country:US
Mailing Address - Phone:315-529-7877
Mailing Address - Fax:315-410-5544
Practice Address - Street 1:188 S 3RD ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1801
Practice Address - Country:US
Practice Address - Phone:315-207-5435
Practice Address - Fax:315-410-5544
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005968101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health