Provider Demographics
NPI:1790938165
Name:BRENNAN, CRYSTAL MAE (LMHC)
Entity Type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:MAE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2033
Mailing Address - Country:US
Mailing Address - Phone:978-777-1187
Mailing Address - Fax:
Practice Address - Street 1:172 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4815
Practice Address - Country:US
Practice Address - Phone:978-744-4033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7441101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7441OtherLICENSED MENTAL HEALTH COUNSELOR