Provider Demographics
NPI:1770897647
Name:BRENNEMAN, JAYME K (LCSW-C)
Entity type:Individual
Prefix:
First Name:JAYME
Middle Name:K
Last Name:BRENNEMAN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-4945
Mailing Address - Country:US
Mailing Address - Phone:717-873-3960
Mailing Address - Fax:
Practice Address - Street 1:213 11TH ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-4945
Practice Address - Country:US
Practice Address - Phone:717-873-3960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW127998104100000X
DCLC500828561041C0700X
MD173591041C0700X
VA09040120641041C0700X
MD13591041S0200X
4238192171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool