1437414281 NPI number — MRS. VALERIE AYANA BRENNAN LCSW

Table of content: MRS. VALERIE AYANA BRENNAN LCSW (NPI 1437414281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437414281 NPI number — MRS. VALERIE AYANA BRENNAN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRENNAN
Provider First Name:
VALERIE
Provider Middle Name:
AYANA
Provider Name Prefix Text:
MRS.
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:
1437414281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14TH MEDICAL GROUP
Provider Second Line Business Mailing Address:
201 INDEPENDENCE DRIVE
Provider Business Mailing Address City Name:
COLUMBUS AFB
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-434-2273
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14TH MEDICAL GROUP
Provider Second Line Business Practice Location Address:
201 INDEPENDENCE DRIVE
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-932-5711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2012

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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