Provider Demographics
NPI:1841455995
Name:BRENNAN, MARILYN M (LISW)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:M
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:NOVELTY
Mailing Address - State:OH
Mailing Address - Zip Code:44072-0401
Mailing Address - Country:US
Mailing Address - Phone:440-552-1633
Mailing Address - Fax:440-338-8932
Practice Address - Street 1:8351 FAIRMOUNT RD
Practice Address - Street 2:
Practice Address - City:NOVELTY
Practice Address - State:OH
Practice Address - Zip Code:44072-9706
Practice Address - Country:US
Practice Address - Phone:440-552-1633
Practice Address - Fax:440-338-8932
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00076211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW27681Medicare PIN