Provider Demographics
NPI:1609960616
Name:BRENNAN, TERRENCE TIERNEY (LCSW, ACSW)
Entity Type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:TIERNEY
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 VENTNOR AVENUE
Mailing Address - Street 2:SUITE# 105
Mailing Address - City:VENTNOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08406
Mailing Address - Country:US
Mailing Address - Phone:609-487-8387
Mailing Address - Fax:609-487-8910
Practice Address - Street 1:6601 VENTNOR AVENUE
Practice Address - Street 2:SUITE# 105
Practice Address - City:VENTNOR
Practice Address - State:NJ
Practice Address - Zip Code:08406
Practice Address - Country:US
Practice Address - Phone:609-487-8387
Practice Address - Fax:609-487-8910
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD070441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical