Provider Demographics
NPI:1477685170
Name:BRENNER, SUSAN J (LCSW LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:BRENNER
Suffix:
Gender:F
Credentials:LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 THOMPSON ST
Mailing Address - Street 2:APT 4A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012
Mailing Address - Country:US
Mailing Address - Phone:212-367-9044
Mailing Address - Fax:212-367-9044
Practice Address - Street 1:817 BROADWAY
Practice Address - Street 2:SUITE 916
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-367-9044
Practice Address - Fax:212-367-9044
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR00710911041C0700X
NY0006561106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
N34091Medicare UPIN