Provider Demographics
NPI:1538510847
Name:BRENNAN, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BRAMBLE PATH
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:MA
Mailing Address - Zip Code:01775-1391
Mailing Address - Country:US
Mailing Address - Phone:508-596-2399
Mailing Address - Fax:978-897-2836
Practice Address - Street 1:14 BRAMBLE PATH
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:MA
Practice Address - Zip Code:01775-1391
Practice Address - Country:US
Practice Address - Phone:508-596-2399
Practice Address - Fax:978-897-2836
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA128103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA128OtherLICENSED APPLIED BEHAVIOR ANALYST (LABA) - MASSACHUSETTS