Provider Demographics
NPI:1710509906
Name:BRENNAN, COLM (LCSW)
Entity Type:Individual
Prefix:
First Name:COLM
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:COLM
Other - Middle Name:
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:50 MARKET ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3646
Mailing Address - Country:US
Mailing Address - Phone:207-352-3248
Mailing Address - Fax:
Practice Address - Street 1:50 MARKET STREET, SUITE 1A
Practice Address - Street 2:PMB 393
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-352-3248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC192051041C0700X
PACW0212771041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical