Provider Demographics
NPI:1720127871
Name:BRENNAN, BRIAN W (THM, MA, LMHC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:THM, MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269B SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903
Mailing Address - Country:US
Mailing Address - Phone:401-351-8752
Mailing Address - Fax:
Practice Address - Street 1:269 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-7130
Practice Address - Country:US
Practice Address - Phone:401-351-8752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health