Provider Demographics
NPI:1851544332
Name:BRENNENSTUHL, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BRENNENSTUHL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR STE 438Q
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6122
Mailing Address - Country:US
Mailing Address - Phone:978-876-9344
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 438Q
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6122
Practice Address - Country:US
Practice Address - Phone:978-876-9344
Practice Address - Fax:978-473-7532
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health