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NPI Code Detail

MEDICARE: DR. CAROL A. BRENNAN PH.D.

MEDICARE: DR. CAROL A. BRENNAN PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor0519NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134239700
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAROL A. BRENNAN PH.D.
Provider Business Mailing Address
First Line : 4686 CORRALES RD
Second Line : #4E
City : CORRALES
State : NM
Zip : 87048-8610
Country : US
Telephone Number : 505-255-7077
Fax Number : 505-890-1313
Provider Business Practice Location Address
First Line : 4686 CORRALES RD
Second Line : #4E
City : CORRALES
State : NM
Zip : 87048-8610
Country : US
Telephone Number : 505-255-7077
Fax Number : 505-890-1313
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 07/08/2007

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