Provider Demographics
NPI:1750473369
Name:BRENNAN, DAVID J (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 ROCKVIEW ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2512
Mailing Address - Country:US
Mailing Address - Phone:617-524-1233
Mailing Address - Fax:
Practice Address - Street 1:729 BOYLSTON ST
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2639
Practice Address - Country:US
Practice Address - Phone:617-524-1233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101074741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical