Provider Demographics
NPI:1518569524
Name:CAROLINE R BRENNER PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:CAROLINE R BRENNER PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-235-7903
Mailing Address - Street 1:1200 E COPELAND RD STE 403
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4938
Mailing Address - Country:US
Mailing Address - Phone:682-235-7903
Mailing Address - Fax:
Practice Address - Street 1:1200 E COPELAND RD STE 403
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4938
Practice Address - Country:US
Practice Address - Phone:682-235-7903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)