Provider Demographics
NPI:1801073770
Name:BRENEISEN, JENNIFER F (LICSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:F
Last Name:BRENEISEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 MASSACHUSETTS AVENUE
Mailing Address - Street 2:METROWEST BEHAVIORAL HEALTH CENTER
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720
Mailing Address - Country:US
Mailing Address - Phone:978-264-3500
Mailing Address - Fax:
Practice Address - Street 1:380 MASSACHUSETTS AVENUE
Practice Address - Street 2:METROWEST BEHAVIORAL HEALTH CENTER
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720
Practice Address - Country:US
Practice Address - Phone:978-264-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1157701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical