Provider Demographics
NPI:1821028176
Name:BRENNAN, TERRI M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:M
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2048
Mailing Address - Country:US
Mailing Address - Phone:716-836-6460
Mailing Address - Fax:716-836-1578
Practice Address - Street 1:3580 HARLEM RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-2048
Practice Address - Country:US
Practice Address - Phone:716-836-6460
Practice Address - Fax:716-836-1578
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0705181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY053231Medicare ID - Type Unspecified