Provider Demographics
NPI:1619215993
Name:GARY S BRENNAN LPC CADC NCC PSYCHOLOGICAL AND ADDICTION SERVICES LLC
Entity Type:Organization
Organization Name:GARY S BRENNAN LPC CADC NCC PSYCHOLOGICAL AND ADDICTION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CADC
Authorized Official - Phone:973-796-8322
Mailing Address - Street 1:362 QUAKER CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-1455
Mailing Address - Country:US
Mailing Address - Phone:973-796-8322
Mailing Address - Fax:973-366-2747
Practice Address - Street 1:362 QUAKER CHURCH RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-1455
Practice Address - Country:US
Practice Address - Phone:973-796-8322
Practice Address - Fax:973-366-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00033700101YA0400X
NJS4065101YM0800X
NJ37PC00464900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty