Provider Demographics
NPI:1477514685
Name:BRENNEN, ERIN J (ATC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:J
Last Name:BRENNEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 RUSSO DR
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-4811
Mailing Address - Country:US
Mailing Address - Phone:617-731-7057
Mailing Address - Fax:617-731-7035
Practice Address - Street 1:400 HEATH ST
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2332
Practice Address - Country:US
Practice Address - Phone:617-731-7057
Practice Address - Fax:617-731-7035
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA742174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist