Provider Demographics
NPI:1265520159
Name:BRENMAN, ALLAN JAY (EDD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:JAY
Last Name:BRENMAN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RICHMOND SQ STE 307E
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5121
Mailing Address - Country:US
Mailing Address - Phone:401-831-5262
Mailing Address - Fax:401-274-4549
Practice Address - Street 1:1 RICHMOND SQ STE 307E
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5121
Practice Address - Country:US
Practice Address - Phone:401-831-5262
Practice Address - Fax:401-274-4549
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI410103T00000X, 103TC2200X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003573Medicaid
RI689003575Medicare ID - Type Unspecified