Provider Demographics
NPI:1407425630
Name:BRENNAN, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06330-1420
Mailing Address - Country:US
Mailing Address - Phone:860-204-2476
Mailing Address - Fax:
Practice Address - Street 1:38 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BALTIC
Practice Address - State:CT
Practice Address - Zip Code:06330-1420
Practice Address - Country:US
Practice Address - Phone:860-204-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.003757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional