Provider Demographics
NPI:1356478044
Name:BRENNAN, RITA (BA)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 MAYO ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6540
Mailing Address - Country:US
Mailing Address - Phone:954-921-8276
Mailing Address - Fax:
Practice Address - Street 1:1957 JACKSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-5021
Practice Address - Country:US
Practice Address - Phone:954-449-2126
Practice Address - Fax:954-497-3857
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator