Provider Demographics
NPI:1982816039
Name:BRENNAN, JACINTA MARIA (LCSW R)
Entity Type:Individual
Prefix:MRS
First Name:JACINTA
Middle Name:MARIA
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:
Other - First Name:JACINTA
Other - Middle Name:MARIA
Other - Last Name:JANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:78 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820
Mailing Address - Country:US
Mailing Address - Phone:607-433-0161
Mailing Address - Fax:
Practice Address - Street 1:78 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820
Practice Address - Country:US
Practice Address - Phone:607-433-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036910104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker