Provider Demographics
NPI:1366467144
Name:BRENNER, MARCY (MS LPC)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:BRENNER
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 ROBERTS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1765
Mailing Address - Country:US
Mailing Address - Phone:717-599-5164
Mailing Address - Fax:
Practice Address - Street 1:3235 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1308
Practice Address - Country:US
Practice Address - Phone:717-234-3839
Practice Address - Fax:717-234-6247
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002671101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50015518OtherCAPITAL BLUE CROSS