Provider Demographics
NPI:1710089289
Name:BRENNER, EDEN J (LICSW)
Entity Type:Individual
Prefix:MS
First Name:EDEN
Middle Name:J
Last Name:BRENNER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 HARVARD ST
Mailing Address - Street 2:STE 1
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2917
Mailing Address - Country:US
Mailing Address - Phone:617-739-3600
Mailing Address - Fax:
Practice Address - Street 1:344 HARVARD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2917
Practice Address - Country:US
Practice Address - Phone:617-739-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA108036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health