1689741233 NPI number — MS. JACQUELINE BRENNAN LCSW

Table of content: MS. JACQUELINE BRENNAN LCSW (NPI 1689741233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689741233 NPI number — MS. JACQUELINE BRENNAN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRENNAN
Provider First Name:
JACQUELINE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689741233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15901 28TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11358-1018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-767-6245
Provider Business Mailing Address Fax Number:
718-767-6245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2350 WATERS EDGE DR
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
BAYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11360-2232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-767-6245
Provider Business Practice Location Address Fax Number:
718-767-6245
Provider Enumeration Date:
11/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  PR0085981 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 132994 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7402648 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".