Provider Demographics
NPI:1669754982
Name:BRENNER, ARLENE SANDRA (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:SANDRA
Last Name:BRENNER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3061
Mailing Address - Country:US
Mailing Address - Phone:845-634-2900
Mailing Address - Fax:845-634-3066
Practice Address - Street 1:441 N LITTLE TOR RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2332
Practice Address - Country:US
Practice Address - Phone:845-638-1548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00-1268-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist