Provider Demographics
NPI:1376567248
Name:BRENNAN, MARY CECILE (PHD, LPCC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CECILE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:PHD, LPCC
Other - Prefix:DR
Other - First Name:M.
Other - Middle Name:CECILE
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1076 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-1234
Mailing Address - Country:US
Mailing Address - Phone:216-221-2534
Mailing Address - Fax:440-899-0266
Practice Address - Street 1:24500 CENTER RIDGE RD
Practice Address - Street 2:BLDG. 4, SUITE 100
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5601
Practice Address - Country:US
Practice Address - Phone:440-899-1300
Practice Address - Fax:440-899-0266
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0002806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2622326Medicaid