Provider Demographics
NPI:1508104159
Name:BRENNER, ELIZABETH L (SPECIAL ED TEACHER)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:BRENNER
Suffix:
Gender:F
Credentials:SPECIAL ED TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3938 EVE DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1553
Mailing Address - Country:US
Mailing Address - Phone:516-993-0872
Mailing Address - Fax:
Practice Address - Street 1:3938 EVE DR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1553
Practice Address - Country:US
Practice Address - Phone:516-993-0872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401669101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist