Provider Demographics
NPI:1417373424
Name:BRENNAN, MELISSA (LSW)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 PENN ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-3543
Mailing Address - Country:US
Mailing Address - Phone:610-373-4281
Mailing Address - Fax:610-373-3779
Practice Address - Street 1:645 PENN ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3543
Practice Address - Country:US
Practice Address - Phone:610-373-4281
Practice Address - Fax:610-373-3779
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131279104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker