Provider Demographics
NPI:1396933727
Name:BRENNER, DANYELL LYNN (LCSW, BCD, PHD)
Entity type:Individual
Prefix:DR
First Name:DANYELL
Middle Name:LYNN
Last Name:BRENNER
Suffix:
Gender:F
Credentials:LCSW, BCD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 482
Mailing Address - Street 2:BOX 2714
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96362 2700
Mailing Address - Country:US
Mailing Address - Phone:315-643-7722
Mailing Address - Fax:
Practice Address - Street 1:BROOKE ARMY MEDICAL CENTER
Practice Address - Street 2:3551 ROGER BROOKE DR.
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:858-888-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490110141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical