Provider Demographics
NPI:1851451561
Name:BRENNAN, PEGGY SPENCE (APRN, CNS)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:SPENCE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:APRN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10520 WARWICK AVE
Mailing Address - Street 2:SUITE B2
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3100
Mailing Address - Country:US
Mailing Address - Phone:703-385-9665
Mailing Address - Fax:
Practice Address - Street 1:10520 WARWICK AVE
Practice Address - Street 2:SUITE B2
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3100
Practice Address - Country:US
Practice Address - Phone:703-385-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000452101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA672660Medicare ID - Type Unspecified