Provider Demographics
NPI:1811317969
Name:BRENNAN, DANIEL (CSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 N 290 W
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-5001
Mailing Address - Country:US
Mailing Address - Phone:801-785-3735
Mailing Address - Fax:801-785-6907
Practice Address - Street 1:197 N 290 W
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-5001
Practice Address - Country:US
Practice Address - Phone:801-785-3735
Practice Address - Fax:801-785-6907
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12302035021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical