Provider Demographics
NPI:1003113754
Name:BRENNER, CHAYA
Entity type:Individual
Prefix:MRS
First Name:CHAYA
Middle Name:
Last Name:BRENNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHAYA
Other - Middle Name:
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC SLP
Mailing Address - Street 1:3608 BANCROFT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3227
Mailing Address - Country:US
Mailing Address - Phone:410-358-1997
Mailing Address - Fax:866-840-6040
Practice Address - Street 1:6414 PARK HTS
Practice Address - Street 2:SUITE T1
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3055
Practice Address - Country:US
Practice Address - Phone:410-318-8561
Practice Address - Fax:866-840-6040
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6376235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist