Provider Demographics
NPI:1134456064
Name:BRENNAN, LEAH (LMFT, CADC)
Entity type:Individual
Prefix:MS
First Name:LEAH
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LMFT, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2956 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1246
Mailing Address - Country:US
Mailing Address - Phone:847-869-0200
Mailing Address - Fax:
Practice Address - Street 1:6834 N. LOWELL AVE.
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712
Practice Address - Country:US
Practice Address - Phone:312-953-0380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000775106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist