Provider Demographics
NPI:1649050519
Name:BRENNEMAN, SAMANTHA JANE (BA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANE
Last Name:BRENNEMAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 SPRING LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3918
Mailing Address - Country:US
Mailing Address - Phone:800-736-3739
Mailing Address - Fax:
Practice Address - Street 1:320 KING OF PRUSSIA RD FL 2
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-4440
Practice Address - Country:US
Practice Address - Phone:610-527-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor