Provider Demographics
NPI:1659441319
Name:BRENNAN-NATHAN, SUZANNE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:BRENNAN-NATHAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:11 GIBBS ST
Mailing Address - Street 2:#3
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6001
Mailing Address - Country:US
Mailing Address - Phone:617-964-1060
Mailing Address - Fax:617-630-0381
Practice Address - Street 1:34 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1507
Practice Address - Country:US
Practice Address - Phone:617-964-1060
Practice Address - Fax:617-630-0381
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105604101YA0400X, 101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA P22012Medicare ID - Type UnspecifiedMEDICARE