Provider Demographics
NPI:1679710826
Name:BRENNAN, GERALDINE (LPC)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2203
Mailing Address - Country:US
Mailing Address - Phone:609-737-0104
Mailing Address - Fax:609-737-0811
Practice Address - Street 1:26 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2203
Practice Address - Country:US
Practice Address - Phone:609-737-0104
Practice Address - Fax:609-737-0811
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00056100101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor