Provider Demographics
NPI:1992868293
Name:BRENNAN, JENNIFER KERINA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KERINA
Last Name:BRENNAN
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:PO BOX 552
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01468-0552
Mailing Address - Country:US
Mailing Address - Phone:781-572-4378
Mailing Address - Fax:
Practice Address - Street 1:309 BELMONT ST.
Practice Address - Street 2:WORCESTER RECOVERY CENTER AND HOSPITAL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604
Practice Address - Country:US
Practice Address - Phone:508-368-3506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1184631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical