Provider Demographics
NPI:1346254711
Name:BRENNAN, ELIZABETH G (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
Last Name:BRENNAN
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 1:34 PARK ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1109
Mailing Address - Country:US
Mailing Address - Phone:203-974-7639
Mailing Address - Fax:203-974-7637
Practice Address - Street 1:270 CENTER ST
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4400
Practice Address - Country:US
Practice Address - Phone:203-974-5913
Practice Address - Fax:203-974-5905
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0029691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
800003375Medicare ID - Type Unspecified