Provider Demographics
NPI:1356785463
Name:BRENNER, EMILY (LCAT, CASAC, ATR-BC)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:
Last Name:BRENNER
Suffix:
Gender:F
Credentials:LCAT, CASAC, ATR-BC
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:TWEEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCAT, CASAC
Mailing Address - Street 1:1639 CENTRE ST # 280
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5335
Mailing Address - Country:US
Mailing Address - Phone:516-680-2883
Mailing Address - Fax:
Practice Address - Street 1:1639 CENTRE ST # 280
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5335
Practice Address - Country:US
Practice Address - Phone:516-680-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY001797-01101Y00000X
NY001797221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor