Provider Demographics
NPI:1942302500
Name:BRENNER, RUTH G (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:G
Last Name:BRENNER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SEWALL AVE APT 57
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5336
Mailing Address - Country:US
Mailing Address - Phone:617-735-1891
Mailing Address - Fax:
Practice Address - Street 1:131 SEWALL AVE APT 57
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5336
Practice Address - Country:US
Practice Address - Phone:617-735-1891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1002921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01236Medicare ID - Type UnspecifiedLICSW