Provider Demographics
NPI:1134206725
Name:BRENNAN, JUDITH (LMHC)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 NE ARCH AVE
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957
Mailing Address - Country:US
Mailing Address - Phone:772-225-2899
Mailing Address - Fax:
Practice Address - Street 1:1111 SE FEDERAL HWY STE 230
Practice Address - Street 2:NEW HORIZONS OF THE TREASURE COAST INC
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-221-4088
Practice Address - Fax:772-221-4089
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5087101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2074GOtherBC BS