Provider Demographics
NPI:1942630017
Name:BRENNAN, JENNIFER E (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
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 1:25 SYLVAN RD. SOUTH
Mailing Address - Street 2:DOOR B
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880
Mailing Address - Country:US
Mailing Address - Phone:203-341-8857
Mailing Address - Fax:
Practice Address - Street 1:25 SYLVAN RD. SOUTH
Practice Address - Street 2:DOOR B
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880
Practice Address - Country:US
Practice Address - Phone:203-341-8857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0422781041C0700X
CT0061181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical