Provider Demographics
NPI:1952670036
Name:BRENNER, KARIN ROSE
Entity Type:Individual
Prefix:MS
First Name:KARIN
Middle Name:ROSE
Last Name:BRENNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 FAIR ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-1305
Mailing Address - Country:US
Mailing Address - Phone:845-225-8441
Mailing Address - Fax:845-228-2307
Practice Address - Street 1:30 FAIR ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-1305
Practice Address - Country:US
Practice Address - Phone:845-225-8441
Practice Address - Fax:845-228-2307
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07706711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical